Provider Demographics
NPI:1669729521
Name:MONTGOMERY, SHIRLEY MEE
Entity type:Individual
Prefix:MRS
First Name:SHIRLEY
Middle Name:MEE
Last Name:MONTGOMERY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 LUCY RD
Mailing Address - Street 2:
Mailing Address - City:LUCASVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:45648-9545
Mailing Address - Country:US
Mailing Address - Phone:740-289-2525
Mailing Address - Fax:
Practice Address - Street 1:110 LUCY RD
Practice Address - Street 2:
Practice Address - City:LUCASVILLE
Practice Address - State:OH
Practice Address - Zip Code:45648-9545
Practice Address - Country:US
Practice Address - Phone:740-289-2525
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-10
Last Update Date:2012-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH374UOOOOOXOtherHOME HEALTH AIDE