Healthcare Provider Details

I. General information

NPI: 1770720633
Provider Name (Legal Business Name): MRS. CAROL ANNE MATTHEWS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/14/2009
Last Update Date: 01/14/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4061 CREEK RD
YOUNGSTOWN NY
14174-9609
US

IV. Provider business mailing address

4061 CREEK RD
YOUNGSTOWN NY
14174-9609
US

V. Phone/Fax

Practice location:
  • Phone: 716-754-8281
  • Fax:
Mailing address:
  • Phone: 716-754-8281
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number003938-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: