Individual
TINA M MONTGOMERY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
COTA/L
Contact information
Practice address
736 POOLE ST, CENTRALIA, MO 65240-1638
(573) 777-0800
Mailing address
736 POOLE ST, CENTRALIA, MO 65240-1638
(573) 777-0800
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
2011000739
MO
Other
Enumeration date
12/26/2011
Last updated
12/26/2011
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