Provider Demographics
NPI:1962913095
Name:MONTGOMERY, MARGARET MECHELLE (RMA/HHA)
Entity type:Individual
Prefix:MRS
First Name:MARGARET
Middle Name:MECHELLE
Last Name:MONTGOMERY
Suffix:
Gender:F
Credentials:RMA/HHA
Other - Prefix:MRS
Other - First Name:MARGARET
Other - Middle Name:MECHELLE
Other - Last Name:MANN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:12939 LAKE VISTA DR
Mailing Address - Street 2:
Mailing Address - City:GIBSONTON
Mailing Address - State:FL
Mailing Address - Zip Code:33534-3900
Mailing Address - Country:US
Mailing Address - Phone:813-464-0828
Mailing Address - Fax:813-373-5448
Practice Address - Street 1:12939 LAKE VISTA DR
Practice Address - Street 2:
Practice Address - City:GIBSONTON
Practice Address - State:FL
Practice Address - Zip Code:33534-3900
Practice Address - Country:US
Practice Address - Phone:813-464-0828
Practice Address - Fax:813-373-5448
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-16
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
374U00000X
FLM532573655270347C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347C00000XTransportation ServicesPrivate Vehicle
No374U00000XNursing Service Related ProvidersHome Health Aide