Provider Demographics
NPI:1225667082
Name:MONTGOMERY, HANNAH NICOLE
Entity Type:Individual
Prefix:
First Name:HANNAH
Middle Name:NICOLE
Last Name:MONTGOMERY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:405 E 16TH ST
Mailing Address - Street 2:
Mailing Address - City:HOPE
Mailing Address - State:AR
Mailing Address - Zip Code:71801-8304
Mailing Address - Country:US
Mailing Address - Phone:870-397-4231
Mailing Address - Fax:
Practice Address - Street 1:1525 MERRILL DR
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72211-1821
Practice Address - Country:US
Practice Address - Phone:501-228-0063
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-03
Last Update Date:2020-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services