Healthcare Provider Details

I. General information

NPI: 1417713256
Provider Name (Legal Business Name): CASSIDY MATTHEWS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/27/2024
Last Update Date: 05/21/2026
Certification Date: 05/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15005 HEALTH CENTER DR
BOWIE MD
20716-1017
US

IV. Provider business mailing address

112 LEXINGTON CT
WARMINSTER PA
18974-2090
US

V. Phone/Fax

Practice location:
  • Phone: 301-805-6070
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number10752
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: