Healthcare Provider Details

I. General information

NPI: 1124792775
Provider Name (Legal Business Name): MATTHEW JOSEPH COWAN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/06/2021
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1355 LAKELAND DR
SCOTT TOWNSHIP PA
18433-7814
US

IV. Provider business mailing address

PO BOX 92
BROOKLYN PA
18813-0092
US

V. Phone/Fax

Practice location:
  • Phone: 570-254-9485
  • Fax: 570-254-6730
Mailing address:
  • Phone: 570-877-3076
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License NumberOC017850
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number026768
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOC017850
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: