Healthcare Provider Details

I. General information

NPI: 1063344380
Provider Name (Legal Business Name): MATTHEW PHILLIPS OTR/L
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/01/2026
Last Update Date: 06/01/2026
Certification Date: 06/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1460 EIGHTH ST
BERKELEY CA
94710-1434
US

IV. Provider business mailing address

2020 BONAR ST
BERKELEY CA
94702-1793
US

V. Phone/Fax

Practice location:
  • Phone: 510-644-6339
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: