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General NPI Number Information
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NPI Number | 1073938668
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Entity Type | Individual
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Provider Name | MATTHEW T LAYNE OTR/L
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Gender | Male
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Dates
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Enumeration Date | 02/19/2014
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Last Update Date | 05/06/2014
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Provider Practice Location Address
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Address Line | 313 MACCORKLE AVE SW
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City | SOUTH CHARLESTON
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State | WV
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Zip | 25303-1263
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Country | US
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Telephone | 304-744-2300
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Fax | 304-744-8195
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Provider Business Mailing Address
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Address Line | 90 JACKSON PIKE
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City | GALLIPOLIS
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State | OH
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Zip | 45631-1560
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Country | US
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Telephone | 304-744-2300
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Fax | 304-744-8195
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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 | 1699
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License Number State | WV
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