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NPI Code Detail

MEDICARE: LORI MATTHEWS OT

MEDICARE: LORI MATTHEWS 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
1225XG0600XGerontology Occupational Therapist104041TX

General Provider Information

NPI Number : 1811420094
Entity Type Code : Individual
Provider Name (Legal Business Name) : LORI MATTHEWS OT
Provider Business Mailing Address
First Line : 5100 RANDOL MILL RD
Second Line :
City : FORT WORTH
State : TX
Zip : 76112-1553
Country : US
Telephone Number : 817-548-3258
Fax Number : 844-618-2754
Provider Business Practice Location Address
First Line : 5100 RANDOL MILL RD
Second Line :
City : FORT WORTH
State : TX
Zip : 76112-1553
Country : US
Telephone Number : 817-548-3258
Fax Number : 844-618-2754
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/05/2017
Last Update Date : 04/05/2017

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Directions to “ LORI MATTHEWS OT” Practice Location

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