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NPI Code Detail

MEDICARE: SUSAN A MONTGOMERY OT

MEDICARE: SUSAN A MONTGOMERY OT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225X00000XOccupational Therapist103036TX
2225XP0200XPediatric Occupational Therapist103036TX

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
181973TOTHERTXBCBS
2103036OTHERTXSTATE BOARD

General Provider Information

NPI Number : 1093813107
Entity Type Code : Individual
Provider Name (Legal Business Name) : SUSAN A MONTGOMERY OT
Provider Business Mailing Address
First Line : PO BOX 162904
Second Line :
City : AUSTIN
State : TX
Zip : 78716-2904
Country : US
Telephone Number : 512-306-1707
Fax Number : 512-306-7380
Provider Business Practice Location Address
First Line : 4613 BEE CAVE RD STE 202
Second Line :
City : WEST LAKE HILLS
State : TX
Zip : 78746-5212
Country : US
Telephone Number : 512-306-1707
Fax Number : 512-306-7380
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/20/2006
Last Update Date : 06/04/2008

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Directions to “ SUSAN A MONTGOMERY OT” Practice Location

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