MEDICARE: HEATHER MONTGOMERY M.ED., BCBA

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	103K00000X	Behavior Analyst	1-12-10179	TX

General Provider Information

NPI Number	:	1699012351
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HEATHER MONTGOMERY M.ED., BCBA

Provider Business Mailing Address
First Line	:	6901 HANSELL RD
Second Line	:	6414
City	:	PLANO
State	:	TX
Zip	:	75024-4214
Country	:	US
Telephone Number	:	832-453-3478
Fax Number	:

Provider Business Practice Location Address
First Line	:	6901 HANSELL RD
Second Line	:	6414
City	:	PLANO
State	:	TX
Zip	:	75024-4214
Country	:	US
Telephone Number	:	832-453-3478
Fax Number	:

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

Provider Enumeration Date	:	01/14/2013
Last Update Date	:	01/14/2013

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