Healthcare Provider Details

I. General information

NPI: 1740076611
Provider Name (Legal Business Name): JOSEPH EARL MATTHEWS MS, OTR/L
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/17/2025
Last Update Date: 04/22/2025
Certification Date: 04/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12520 PROSPERITY DR STE 220
SILVER SPRING MD
20904-1660
US

IV. Provider business mailing address

101 OAKWAY RD
LUTHERVILLE TIMONIUM MD
21093-4340
US

V. Phone/Fax

Practice location:
  • Phone: 301-869-7505
  • Fax:
Mailing address:
  • Phone: 580-480-2062
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number529929
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number529929
License Number StateMD
# 3
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number529929
License Number StateMD

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: