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NPI Code Detail

MEDICARE: MISS HOLLY S MONTGOMERY OTR

MEDICARE: MISS HOLLY S MONTGOMERY OTR
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 Therapist056.007835IL
2225X00000XOccupational Therapist112860TX

General Provider Information

NPI Number : 1235299728
Entity Type Code : Individual
Provider Name (Legal Business Name) : MISS HOLLY S MONTGOMERY OTR
Provider Business Mailing Address
First Line : 601 W LOOP 340
Second Line :
City : WACO
State : TX
Zip : 76712-6840
Country : US
Telephone Number : 254-399-8255
Fax Number : 254-235-3408
Provider Business Practice Location Address
First Line : 601 W LOOP 340
Second Line :
City : WACO
State : TX
Zip : 76712-6840
Country : US
Telephone Number : 254-399-8255
Fax Number : 254-235-3408
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/12/2006
Last Update Date : 07/17/2019

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Directions to “ MISS HOLLY S MONTGOMERY OTR” Practice Location

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