Provider Demographics
NPI:1124272182
Name:MONTGOMERY, TIFFANY CHRISTEEN (MOT)
Entity type:Individual
Prefix:
First Name:TIFFANY
Middle Name:CHRISTEEN
Last Name:MONTGOMERY
Suffix:
Gender:F
Credentials:MOT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2901 ACME BRICK PLZ
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76109-4214
Mailing Address - Country:US
Mailing Address - Phone:817-529-1900
Mailing Address - Fax:817-735-8884
Practice Address - Street 1:7277 HAWKINS VIEW DR
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76132-3921
Practice Address - Country:US
Practice Address - Phone:817-423-5611
Practice Address - Fax:817-423-5577
Is Sole Proprietor?:No
Enumeration Date:2008-11-04
Last Update Date:2019-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX112576225XP0019X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0019XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPhysical Rehabilitation