Healthcare Provider Details

I. General information

NPI: 1992864631
Provider Name (Legal Business Name): ANN M MATYAS OTR CHT LA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/08/2006
Last Update Date: 10/03/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2501 W BELTLINE HWY SUITE 601
MADISON WI
53713-2318
US

IV. Provider business mailing address

2501 W BELTLINE HWY SUITE 601
MADISON WI
53713-2318
US

V. Phone/Fax

Practice location:
  • Phone: 608-294-6464
  • Fax: 608-288-6496
Mailing address:
  • Phone: 608-294-6464
  • Fax: 608-288-6496

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225XH1200X
TaxonomyHand Occupational Therapist
License Number2728-026
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number2728-26
License Number StateWI
# 3
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number635-55
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: