Provider Demographics
NPI:1417282773
Name:MONTGOMERY, PAMELA J
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:J
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 1:836 HUMMINGBIRD RD
Mailing Address - Street 2:
Mailing Address - City:OZARK
Mailing Address - State:MO
Mailing Address - Zip Code:65721-7192
Mailing Address - Country:US
Mailing Address - Phone:417-581-8907
Mailing Address - Fax:
Practice Address - Street 1:1948 E CHESAPEAKE DR
Practice Address - Street 2:
Practice Address - City:OZARK
Practice Address - State:MO
Practice Address - Zip Code:65721-7815
Practice Address - Country:US
Practice Address - Phone:417-551-3210
Practice Address - Fax:888-527-0428
Is Sole Proprietor?:No
Enumeration Date:2009-10-05
Last Update Date:2009-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO002223225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist