Healthcare Provider Details

I. General information

NPI: 1497253199
Provider Name (Legal Business Name): MATTHEW PLEN OTR/L, DOR
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/28/2018
Last Update Date: 01/28/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 FRANKLIN TOWN BLVD
PHILADELPHIA PA
19103-1238
US

IV. Provider business mailing address

1500 MOUNT VERNON ST APT 3R
PHILADELPHIA PA
19130-3403
US

V. Phone/Fax

Practice location:
  • Phone: 860-597-3274
  • Fax:
Mailing address:
  • Phone: 860-597-3274
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0019X
TaxonomyPhysical Rehabilitation Occupational Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: