Provider Demographics
NPI:1467830133
Name:MONTGOMERY, KARIE (OTR/L)
Entity Type:Individual
Prefix:
First Name:KARIE
Middle Name:
Last Name:MONTGOMERY
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:KARIE
Other - Middle Name:
Other - Last Name:FRANCEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR/L
Mailing Address - Street 1:14387 EDGEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:BAXTER
Mailing Address - State:MN
Mailing Address - Zip Code:56425-8460
Mailing Address - Country:US
Mailing Address - Phone:218-454-5184
Mailing Address - Fax:844-795-7474
Practice Address - Street 1:14387 EDGEWOOD DR
Practice Address - Street 2:
Practice Address - City:BAXTER
Practice Address - State:MN
Practice Address - Zip Code:56425-8460
Practice Address - Country:US
Practice Address - Phone:952-544-0349
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-05-13
Last Update Date:2021-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
2255A2300X
MN106406225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer