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General NPI Number Information
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NPI Number | 1184422495
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Entity Type | Individual
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Provider Name | MATTHEW PAUL PEVERLY OT
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Gender | Male
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Dates
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Enumeration Date | 03/04/2025
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Last Update Date | 03/20/2025
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Provider Practice Location Address
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Address Line | 275 STEELE RD
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City | WEST HARTFORD
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State | CT
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Zip | 06117-2716
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Country | US
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Telephone | 860-920-6319
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Fax |
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Provider Business Mailing Address
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Address Line | 100 BUSHY HILL RD
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City | GRANBY
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State | CT
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Zip | 06035-1622
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Country | US
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Telephone | 405-534-0795
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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 | 225XG0600X
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Taxonomy Name | Gerontology Occupational Therapist
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License Number | 6483
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License Number State | CT
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