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NPI Code Detail

MEDICARE: CHRIS MATHIAS

MEDICARE: CHRIS MATHIAS
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1224Z00000XOccupational Therapy AssistantOTA303FL

General Provider Information

NPI Number : 1164004271
Entity Type Code : Individual
Provider Name (Legal Business Name) : CHRIS MATHIAS
Provider Business Mailing Address
First Line : 102 CAROLINA AVE
Second Line :
City : LYNN HAVEN
State : FL
Zip : 32444-1239
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 3611 TRANSMITTER RD
Second Line :
City : PANAMA CITY
State : FL
Zip : 32404-9799
Country : US
Telephone Number : 850-588-4643
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/27/2021
Last Update Date : 04/27/2021

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Directions to “ CHRIS MATHIAS ” Practice Location

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