Provider Demographics
NPI:1730513078
Name:MONTGOMERY, CAROLINE M (AVED - CERTIFIED)
Entity type:Individual
Prefix:MRS
First Name:CAROLINE
Middle Name:M
Last Name:MONTGOMERY
Suffix:
Gender:F
Credentials:AVED - CERTIFIED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 N 8TH ST
Mailing Address - Street 2:PO BOX 19662
Mailing Address - City:SPRINGFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62701-1041
Mailing Address - Country:US
Mailing Address - Phone:217-545-8000
Mailing Address - Fax:217-545-7386
Practice Address - Street 1:301 N 8TH ST
Practice Address - Street 2:SUITE PAV 5B
Practice Address - City:SPRINGFIELD
Practice Address - State:IL
Practice Address - Zip Code:62701-1041
Practice Address - Country:US
Practice Address - Phone:217-545-8000
Practice Address - Fax:217-545-7386
Is Sole Proprietor?:No
Enumeration Date:2013-08-22
Last Update Date:2015-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist