MEDICARE: MRS. ANNE MATHEW

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	14133	CA

General Provider Information

NPI Number	:	1417345737
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ANNE MATHEW

Provider Business Mailing Address
First Line	:	2960 W ORANGE AVE
Second Line	:	APT # 9
City	:	ANAHEIM
State	:	CA
Zip	:	92804-3277
Country	:	US
Telephone Number	:	714-406-6131
Fax Number	:

Provider Business Practice Location Address
First Line	:	2960 W ORANGE AVE
Second Line	:	APT # 9
City	:	ANAHEIM
State	:	CA
Zip	:	92804-3277
Country	:	US
Telephone Number	:	714-406-6131
Fax Number	:

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

Provider Enumeration Date	:	01/08/2015
Last Update Date	:	01/08/2015

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