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General NPI Number Information
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NPI Number | 1194274969
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Entity Type | Individual
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Provider Name | SERIN MATHEW
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Gender | Female
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Dates
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Enumeration Date | 09/22/2016
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Last Update Date | 09/22/2016
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Provider Practice Location Address
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Address Line | 191 ASTAIRE LN
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City | SPRING HILL
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State | FL
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Zip | 34609-5817
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Country | US
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Telephone | 352-200-2218
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Fax |
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Provider Business Mailing Address
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Address Line | 2550 STAG RUN BLVD APT 534
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City | CLEARWATER
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State | FL
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Zip | 33765-1840
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Country | US
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Telephone | 727-831-3481
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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 | 224Z00000X
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Taxonomy Name | Occupational Therapy Assistant
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License Number | OTA 15352
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License Number State | FL
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