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NPI Code Detail

MEDICARE: MRS. ANNETTE MARIE MATTHEWS OTR

MEDICARE: MRS. ANNETTE MARIE MATTHEWS OTR
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
1225X00000XOccupational Therapist

General Provider Information

NPI Number : 1629571294
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. ANNETTE MARIE MATTHEWS OTR
Provider Business Mailing Address
First Line : 5343 CHICKASAW TRL
Second Line :
City : FLUSHING
State : MI
Zip : 48433-1091
Country : US
Telephone Number : 810-424-3880
Fax Number :
Provider Business Practice Location Address
First Line : 9317 VIENNA RD
Second Line :
City : MONTROSE
State : MI
Zip : 48457-9729
Country : US
Telephone Number : 810-639-6171
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/09/2018
Last Update Date : 03/09/2018

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