Provider Demographics
NPI:1437547312
Name:MONTGOMERY, MONICA I
Entity Type:Individual
Prefix:
First Name:MONICA
Middle Name:
Last Name:MONTGOMERY
Suffix:I
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MONICA
Other - Middle Name:
Other - Last Name:WIGGINTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:COTA/L
Mailing Address - Street 1:8005 U.S. 60
Mailing Address - Street 2:
Mailing Address - City:LEWISPORT
Mailing Address - State:KY
Mailing Address - Zip Code:42351
Mailing Address - Country:US
Mailing Address - Phone:270-314-9913
Mailing Address - Fax:
Practice Address - Street 1:8005 U.S. 60
Practice Address - Street 2:
Practice Address - City:LEWISPORT
Practice Address - State:KY
Practice Address - Zip Code:42351
Practice Address - Country:US
Practice Address - Phone:270-314-9913
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-31
Last Update Date:2014-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYA2235224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant