Healthcare Provider Details

I. General information

NPI: 1154566685
Provider Name (Legal Business Name): JAMES MATTHEW HORN OTR/L
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/12/2008
Last Update Date: 07/07/2022
Certification Date: 07/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18 TIMBER RIDGE TRL
LORENA TX
76655-3035
US

IV. Provider business mailing address

18 TIMBER RIDGE TRL
LORENA TX
76655-3035
US

V. Phone/Fax

Practice location:
  • Phone: 315-569-7838
  • Fax:
Mailing address:
  • Phone: 315-569-7838
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number006691-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: