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General NPI Number Information
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NPI Number | 1891407417
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Entity Type | Individual
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Provider Name | CASEY J MONTAGUE H.I.S.
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Gender | Female
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Dates
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Enumeration Date | 12/14/2022
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Last Update Date | 12/14/2022
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Provider Practice Location Address
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Address Line | 2130 N CHARLES G SEIVERS BLVD STE 2
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City | CLINTON
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State | TN
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Zip | 37716-6705
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Country | US
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Telephone | 931-709-0661
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Fax |
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Provider Business Mailing Address
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Address Line | 119 BIRCHWOOD LN
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City | CROSSVILLE
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State | TN
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Zip | 38555-4189
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Country | US
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Telephone | 931-709-0661
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Fax | 931-709-0661
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 237700000X
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Taxonomy Name | Hearing Instrument Specialist
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License Number | 1027
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License Number State | TN
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