Provider Demographics
NPI:1629258496
Name:MONTGOMERY, JALEY ANNE (MT-BC)
Entity Type:Individual
Prefix:
First Name:JALEY
Middle Name:ANNE
Last Name:MONTGOMERY
Suffix:
Gender:F
Credentials:MT-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:325 WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:IN
Mailing Address - Zip Code:47620-1135
Mailing Address - Country:US
Mailing Address - Phone:812-319-3268
Mailing Address - Fax:
Practice Address - Street 1:325 WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:IN
Practice Address - Zip Code:47620-1135
Practice Address - Country:US
Practice Address - Phone:812-319-3268
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-09
Last Update Date:2007-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic Therapist