Provider Demographics
NPI:1235299728
Name:MONTGOMERY, HOLLY S (OTR)
Entity type:Individual
Prefix:MISS
First Name:HOLLY
Middle Name:S
Last Name:MONTGOMERY
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 W LOOP 340
Mailing Address - Street 2:
Mailing Address - City:WACO
Mailing Address - State:TX
Mailing Address - Zip Code:76712-6840
Mailing Address - Country:US
Mailing Address - Phone:254-399-8255
Mailing Address - Fax:254-235-3408
Practice Address - Street 1:601 W LOOP 340
Practice Address - Street 2:
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76712-6840
Practice Address - Country:US
Practice Address - Phone:254-399-8255
Practice Address - Fax:254-235-3408
Is Sole Proprietor?:No
Enumeration Date:2006-12-12
Last Update Date:2019-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL056.007835225X00000X
TX112860225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist