MEDICARE: KELLY MATTHEWS

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
2	225XP0019X	Physical Rehabilitation Occupational Therapist	04632
3	225X00000X	Occupational Therapist	4632	OH

General Provider Information

NPI Number	:	1821831181
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KELLY MATTHEWS

Provider Business Mailing Address
First Line	:	500 STANTON BLVD
Second Line	:
City	:	STEUBENVILLE
State	:	OH
Zip	:	43952-3706
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	500 STANTON BLVD
Second Line	:
City	:	STEUBENVILLE
State	:	OH
Zip	:	43952-3706
Country	:	US
Telephone Number	:	740-264-5042
Fax Number	:

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

Provider Enumeration Date	:	06/14/2024
Last Update Date	:	06/14/2024

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