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General NPI Number Information
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NPI Number | 1588765929
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Entity Type | Organization
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Legal Business Name | HARRY T MATHIVHA
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Dates
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Enumeration Date | 09/26/2006
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Last Update Date | 06/17/2008
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Provider Practice Location Address
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Address Line | 985 E MARIETTA RD
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City | MCCONNELSVILLE
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State | OH
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Zip | 43756-9768
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Country | US
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Telephone | 740-962-2152
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Fax |
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Provider Business Mailing Address
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Address Line | 103 ARBORGATE DR
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City | MARIETTA
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State | OH
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Zip | 45750-9224
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Country | US
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Telephone | 740-962-2152
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MR. HARRY TSHIFHIWA MATHIVHA
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Credential | OTR/L
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Telephone | 740-962-2152
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number | OT.003354
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License Number State | OH
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