Individual
MRS. MICHELLE MONTGOMERY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
COTA/L
Contact information
Practice address
5619 N 47TH AVE, GLENDALE, AZ 85301-6224
(602) 264-3824
Mailing address
5619 N 47TH AVE, GLENDALE, AZ 85301-6224
(602) 264-3824
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
0803
AZ
Other
Enumeration date
09/24/2008
Last updated
09/24/2008
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