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General NPI Number Information
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NPI Number | 1154137404
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Entity Type | Individual
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Provider Name | MATTHEW LEE PAINTER OTR/L
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Gender | Male
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Dates
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Enumeration Date | 12/10/2024
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Last Update Date | 12/10/2024
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Provider Practice Location Address
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Address Line | 501 V E S RD
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City | LYNCHBURG
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State | VA
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Zip | 24503-4638
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Country | US
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Telephone | 919-943-7534
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Fax |
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Provider Business Mailing Address
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Address Line | 12000 E LYNCHBURG SALEM TPKE
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City | FOREST
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State | VA
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Zip | 24551-3422
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Country | US
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Telephone |
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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 | 0119007396
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License Number State | VA
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