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General NPI Number Information
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NPI Number | 1265392211
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Entity Type | Individual
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Provider Name | ANALEICIA MATTHEWS
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Gender | Female
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Dates
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Enumeration Date | 11/13/2025
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Last Update Date | 11/13/2025
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Provider Practice Location Address
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Address Line | 1530 BROAD AVE
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City | GULFPORT
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State | MS
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Zip | 39501-3601
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Country | US
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Telephone | 228-864-6544
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Fax |
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Provider Business Mailing Address
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Address Line | 117 VAN BUREN AVE
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City | BILOXI
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State | MS
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Zip | 39531-3324
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Country | US
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Telephone | 970-430-7647
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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 | 4090
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License Number State | MS
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