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NPI Code Detail

MEDICARE: MATTHEW D MITCHELL OT

MEDICARE: MATTHEW D MITCHELL OT
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
1225X00000XOccupational TherapistOT004389OH

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1000000325537OTHEROHANTHEM BLUE CROSS

General Provider Information

NPI Number : 1295705424
Entity Type Code : Individual
Provider Name (Legal Business Name) : MATTHEW D MITCHELL OT
Provider Business Mailing Address
First Line : 1069 US HIGHWAY 224
Second Line :
City : NOVA
State : OH
Zip : 44859-9770
Country : US
Telephone Number : 419-652-2219
Fax Number : 419-652-2219
Provider Business Practice Location Address
First Line : 1069 US HIGHWAY 224
Second Line :
City : NOVA
State : OH
Zip : 44859-9770
Country : US
Telephone Number : 419-652-2219
Fax Number : 419-652-2219
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/23/2006
Last Update Date : 07/08/2007

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Directions to “ MATTHEW D MITCHELL OT” Practice Location

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