Provider Demographics
NPI:1699049890
Name:MUTH, MICHELLE MONTGOMERY (MT-BC)
Entity type:Individual
Prefix:MS
First Name:MICHELLE
Middle Name:MONTGOMERY
Last Name:MUTH
Suffix:
Gender:F
Credentials:MT-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:184 RICHARD DR
Mailing Address - Street 2:
Mailing Address - City:ALIQUIPPA
Mailing Address - State:PA
Mailing Address - Zip Code:15001-1513
Mailing Address - Country:US
Mailing Address - Phone:978-578-5233
Mailing Address - Fax:
Practice Address - Street 1:184 RICHARD DR
Practice Address - Street 2:
Practice Address - City:ALIQUIPPA
Practice Address - State:PA
Practice Address - Zip Code:15001-1513
Practice Address - Country:US
Practice Address - Phone:978-578-5233
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-06
Last Update Date:2012-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA09373225A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic Therapist