MEDICARE: MR. HARRY TSHIFHIWA MATHIVHA OTR/L

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
1	225X00000X	Occupational Therapist	OT. 003354	OH

General Provider Information

NPI Number	:	1598704942
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. HARRY TSHIFHIWA MATHIVHA OTR/L

Provider Business Mailing Address
First Line	:	103 ARBORGATE DR
Second Line	:
City	:	MARIETTA
State	:	OH
Zip	:	45750-9224
Country	:	US
Telephone Number	:	740-374-5049
Fax Number	:	740-374-5049

Provider Business Practice Location Address
First Line	:	985 E MARIETTA RD NW
Second Line	:
City	:	MC CONNELSVILLE
State	:	OH
Zip	:	43756-9768
Country	:	US
Telephone Number	:	740-962-2152
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/04/2006
Last Update Date	:	06/03/2008

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