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NPI Code Detail

MEDICARE: COLLEEN CASEY MATTIOLI MS, OTR/L

MEDICARE: COLLEEN CASEY MATTIOLI MS, OTR/L
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 Therapist11622NC

General Provider Information

NPI Number : 1336630243
Entity Type Code : Individual
Provider Name (Legal Business Name) : COLLEEN CASEY MATTIOLI MS, OTR/L
Provider Business Mailing Address
First Line : 13606 STRATHAVEN DR
Second Line :
City : MATTHEWS
State : NC
Zip : 28105-4093
Country : US
Telephone Number : 585-746-6415
Fax Number :
Provider Business Practice Location Address
First Line : 6000 PARK SOUTH DR
Second Line :
City : CHARLOTTE
State : NC
Zip : 28210-3298
Country : US
Telephone Number : 704-643-1400
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/25/2018
Last Update Date : 05/25/2018

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