Provider Demographics
NPI:1609306034
Name:MONTGOMERY, FELICIA GREEN (CERTIFIED HAIR LOSS)
Entity Type:Individual
Prefix:MS
First Name:FELICIA
Middle Name:GREEN
Last Name:MONTGOMERY
Suffix:
Gender:F
Credentials:CERTIFIED HAIR LOSS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1432 PITCHING WEDGE DR APT 304
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27603-2876
Mailing Address - Country:US
Mailing Address - Phone:919-345-4530
Mailing Address - Fax:
Practice Address - Street 1:1432 PITCHING WEDGE DR APT 304
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27603-2876
Practice Address - Country:US
Practice Address - Phone:919-345-4530
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-18
Last Update Date:2020-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1744P3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1744P3200XOther Service ProvidersSpecialistProsthetics Case Management