Healthcare Provider Details

I. General information

NPI: 1730631540
Provider Name (Legal Business Name): MATTHEW DELEWSKI OTR/L
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/27/2016
Last Update Date: 10/27/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2181 AMBLESIDE DR
CLEVELAND OH
44106-4645
US

IV. Provider business mailing address

2181 AMBLESIDE DR
CLEVELAND OH
44106-4645
US

V. Phone/Fax

Practice location:
  • Phone: 216-721-1234
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT009546
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: