MEDICARE: MATTHEW THOMAS MOTR/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
1	225XP0019X	Physical Rehabilitation Occupational Therapist	10090	MA

General Provider Information

NPI Number	:	1396377388
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MATTHEW THOMAS MOTR/L

Provider Business Mailing Address
First Line	:	4 CAPTAIN PERKINS DR
Second Line	:
City	:	CARVER
State	:	MA
Zip	:	02330-1066
Country	:	US
Telephone Number	:	904-607-8730
Fax Number	:

Provider Business Practice Location Address
First Line	:	222 FORBES RD
Second Line	:
City	:	BRAINTREE
State	:	MA
Zip	:	02184-2706
Country	:	US
Telephone Number	:	781-356-7400
Fax Number	:

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

Provider Enumeration Date	:	02/07/2020
Last Update Date	:	02/07/2020

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