Individual
SUSAN A MONTGOMERY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OT
Contact information
Practice address
4613 BEE CAVE RD STE 202, WEST LAKE HILLS, TX 78746-5212
(512) 306-1707
(512) 306-7380
Mailing address
PO BOX 162904, AUSTIN, TX 78716-2904
(512) 306-1707
(512) 306-7380
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
103036
TX
225XP0200X
Pediatric Occupational Therapist
Primary
103036
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
103036
STATE BOARD
TX
01
—
81973T
BCBS
TX
Enumeration date
09/20/2006
Last updated
06/04/2008
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