Provider Demographics
NPI:1982292363
Name:MONTAVON, LORIE
Entity Type:Individual
Prefix:
First Name:LORIE
Middle Name:
Last Name:MONTAVON
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 1:38 SHUMWAY HOLLOW RD
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:OH
Mailing Address - Zip Code:45662-8635
Mailing Address - Country:US
Mailing Address - Phone:740-727-2334
Mailing Address - Fax:
Practice Address - Street 1:38 SHUMWAY HOLLOW RD
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:OH
Practice Address - Zip Code:45662-8635
Practice Address - Country:US
Practice Address - Phone:740-727-2334
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-01
Last Update Date:2021-01-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health