MEDICARE: MS. ALTHEA MONTGOMERY

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
1	225X00000X	Occupational Therapist	056-005430	IL
2	225XP0200X	Pediatric Occupational Therapist	056-005430	IL
3	225XP0200X	Pediatric Occupational Therapist	2534	GA
4	225X00000X	Occupational Therapist	OT0007107	FL
5	225X00000X	Occupational Therapist	1586	AL
6	226300000X	Kinesiotherapist	1263	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1457346769
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. ALTHEA MONTGOMERY

Provider Business Mailing Address
First Line	:	10459 TARA BEACH CIR
Second Line	:
City	:	JONESBORO
State	:	GA
Zip	:	30238-7955
Country	:	US
Telephone Number	:	678-230-7272
Fax Number	:	770-478-5214

Provider Business Practice Location Address
First Line	:	10459 TARA BEACH CIR
Second Line	:
City	:	JONESBORO
State	:	GA
Zip	:	30238-7955
Country	:	US
Telephone Number	:	678-230-7272
Fax Number	:	770-478-5214

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/13/2005
Last Update Date	:	08/14/2007

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Directions to “ MS. ALTHEA MONTGOMERY ” Practice Location

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