Provider Demographics
NPI:1568070332
Name:MONTGOMERY, SCOTT ROBERT (OTR/L)
Entity Type:Individual
Prefix:MR
First Name:SCOTT
Middle Name:ROBERT
Last Name:MONTGOMERY
Suffix:
Gender:M
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2725 CARRETERA
Mailing Address - Street 2:
Mailing Address - City:SAN CLEMENTE
Mailing Address - State:CA
Mailing Address - Zip Code:92673-4026
Mailing Address - Country:US
Mailing Address - Phone:949-378-2974
Mailing Address - Fax:
Practice Address - Street 1:27783 CENTER DR
Practice Address - Street 2:
Practice Address - City:MISSION VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92692-3603
Practice Address - Country:US
Practice Address - Phone:949-391-6904
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-17
Last Update Date:2020-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA10743225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist