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General NPI Number Information
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NPI Number | 1053854414
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Entity Type | Individual
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Provider Name | MATTHEW METZGER OT
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Gender | Male
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Dates
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Enumeration Date | 12/02/2016
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Last Update Date | 05/04/2018
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Provider Practice Location Address
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Address Line | 4355 PHEASANT RIDGE RD
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City | ROANOKE
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State | VA
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Zip | 24014-5272
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Country | US
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Telephone | 540-725-5368
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Fax |
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Provider Business Mailing Address
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Address Line | 23 JACKSON DR
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City | MONESSEN
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State | PA
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Zip | 15062-2501
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Country | US
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Telephone | 724-454-5668
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | OC014834
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | OT18120
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 31006597A
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License Number State | IN
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Taxonomy #4
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 0119-007727
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License Number State | VA
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