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NPI Code Detail

MEDICARE: AMY MATTHEWS OTRL

MEDICARE: AMY MATTHEWS OTRL
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1224Z00000XOccupational Therapy Assistant
2225XP0200XPediatric Occupational Therapist31004919AIN

General Provider Information

NPI Number : 1326244153
Entity Type Code : Individual
Provider Name (Legal Business Name) : AMY MATTHEWS OTRL
Provider Business Mailing Address
First Line : 8350 CRAIG ST
Second Line :
City : INDIANAPOLIS
State : IN
Zip : 46250-3593
Country : US
Telephone Number : 317-578-0410
Fax Number :
Provider Business Practice Location Address
First Line : 8350 CRAIG ST
Second Line :
City : INDIANAPOLIS
State : IN
Zip : 46250-3593
Country : US
Telephone Number : 317-578-0410
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/27/2007
Last Update Date : 04/25/2023

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