MEDICARE: SERENA MATTHEWS OCCUPATIONAL THERAPY SERVICES LLC

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	00003730	WA

General Provider Information

NPI Number	:	1255706982
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SERENA MATTHEWS OCCUPATIONAL THERAPY SERVICES LLC

Provider Business Mailing Address
First Line	:	11287 FIELDSTONE LN NE
Second Line	:
City	:	BAINBRIDGE ISLAND
State	:	WA
Zip	:	98110-4282
Country	:	US
Telephone Number	:	206-718-0795
Fax Number	:

Provider Business Practice Location Address
First Line	:	11287 FIELDSTONE LN NE
Second Line	:
City	:	BAINBRIDGE ISLAND
State	:	WA
Zip	:	98110-4282
Country	:	US
Telephone Number	:	206-718-0795
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	SERENA B MATTHEWS
Credential	:
Telephone Number	:	206-718-0795

Provider Enumeration Date	:	12/07/2015
Last Update Date	:	12/07/2015

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