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General NPI Number Information
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NPI Number | 1922655406
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Entity Type | Individual
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Provider Name | JESSICA NICOLE MATOS M.S. ATR
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Gender | Female
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Dates
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Enumeration Date | 08/20/2019
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Last Update Date | 08/20/2019
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Provider Practice Location Address
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Address Line | 3400 HUNTERS CREEK BLVD
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City | ORLANDO
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State | FL
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Zip | 32837-7230
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Country | US
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Telephone | 407-650-3073
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Fax |
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Provider Business Mailing Address
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Address Line | 15851 SW 51ST ST
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City | MIRAMAR
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State | FL
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Zip | 33027-4976
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Country | US
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Telephone | 407-595-3915
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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 | 221700000X
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Taxonomy Name | Art Therapist
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License Number | 18-515
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License Number State | FL
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