MEDICARE: MRS. JULIETTE M MATIS OT

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	OT12179	FL

General Provider Information

NPI Number	:	1669480364
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JULIETTE M MATIS OT

Provider Business Mailing Address
First Line	:	9980 CENTRAL PARK BLVD N STE 102
Second Line	:
City	:	BOCA RATON
State	:	FL
Zip	:	33428-1703
Country	:	US
Telephone Number	:	561-470-2205
Fax Number	:	561-470-2215

Provider Business Practice Location Address
First Line	:	9980 CENTRAL PARK BLVD N STE 102
Second Line	:
City	:	BOCA RATON
State	:	FL
Zip	:	33428-1703
Country	:	US
Telephone Number	:	561-470-2205
Fax Number	:	561-470-2215

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

Provider Enumeration Date	:	08/04/2006
Last Update Date	:	12/08/2014

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