Healthcare Provider Details

I. General information

NPI: 1356775886
Provider Name (Legal Business Name): MATHEW RONALD STEADMAN OT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/03/2013
Last Update Date: 09/03/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1025 ROBERTA LN
SPARKS NV
89431-1893
US

IV. Provider business mailing address

1025 ROBERTA LN
SPARKS NV
89431-1893
US

V. Phone/Fax

Practice location:
  • Phone: 775-825-4744
  • Fax: 775-351-1644
Mailing address:
  • Phone: 775-825-4744
  • Fax: 775-351-1644

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number13-0362
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: