Individual
SHYVON REESE MONTGOMERY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
540 SUNNYSIDE DR, FLUSHING, MI 48433-1474
(810) 659-5695
Mailing address
540 SUNNYSIDE DR, FLUSHING, MI 48433-1474
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
5201007149
MI
225XG0600X
Gerontology Occupational Therapist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1114966983
—
MI
Enumeration date
11/21/2018
Last updated
08/13/2021
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