MEDICARE: MATTHEW PAUL ANDERSON

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	224Z00000X	Occupational Therapy Assistant	11815	FL

General Provider Information

NPI Number	:	1225325061
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MATTHEW PAUL ANDERSON

Provider Business Mailing Address
First Line	:	11483 PETREL AVE
Second Line	:
City	:	WEEKI WACHEE
State	:	FL
Zip	:	34614-2730
Country	:	US
Telephone Number	:	585-451-3731
Fax Number	:

Provider Business Practice Location Address
First Line	:	11483 PETREL AVE
Second Line	:
City	:	WEEKI WACHEE
State	:	FL
Zip	:	34614-2730
Country	:	US
Telephone Number	:	585-451-3731
Fax Number	:

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

Provider Enumeration Date	:	06/30/2011
Last Update Date	:	06/30/2011

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