MEDICARE: NIKITA MATHEW

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
1	225X00000X	Occupational Therapist	OT 18320	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1184159345
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NIKITA MATHEW

Provider Business Mailing Address
First Line	:	10906 NW 46TH DR
Second Line	:
City	:	CORAL SPRINGS
State	:	FL
Zip	:	33076-2132
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	10906 NW 46TH DR
Second Line	:
City	:	CORAL SPRINGS
State	:	FL
Zip	:	33076-2132
Country	:	US
Telephone Number	:	954-729-9398
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/25/2017
Last Update Date	:	03/06/2019

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Directions to “ NIKITA MATHEW ” Practice Location

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