Provider Demographics
NPI:1578173811
Name:MONTGOMERY, PATRICK H (OTR/L)
Entity Type:Individual
Prefix:MR
First Name:PATRICK
Middle Name:H
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 1:111 POPLAR LN
Mailing Address - Street 2:
Mailing Address - City:MOUNT WOLF
Mailing Address - State:PA
Mailing Address - Zip Code:17347-9604
Mailing Address - Country:US
Mailing Address - Phone:717-495-3979
Mailing Address - Fax:
Practice Address - Street 1:1493 S QUEEN ST
Practice Address - Street 2:
Practice Address - City:YORK
Practice Address - State:PA
Practice Address - Zip Code:17403-3852
Practice Address - Country:US
Practice Address - Phone:717-854-2029
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-02
Last Update Date:2020-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOC016935225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist