Provider Demographics
NPI:1477012284
Name:MONTGOMERY, ERICA L (MSHA)
Entity Type:Individual
Prefix:MS
First Name:ERICA
Middle Name:L
Last Name:MONTGOMERY
Suffix:
Gender:F
Credentials:MSHA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 36542
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77236-6542
Mailing Address - Country:US
Mailing Address - Phone:228-284-7757
Mailing Address - Fax:
Practice Address - Street 1:23223 FIRST PARK DR APT 7306
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77449-2553
Practice Address - Country:US
Practice Address - Phone:228-284-7757
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-19
Last Update Date:2021-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX802652248OtherSATE IDENTIFICATION NUMBER