MEDICARE: MATTHEW KUPSTAS 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
1	225X00000X	Occupational Therapist	12147	NC

General Provider Information

NPI Number	:	1871069914
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MATTHEW KUPSTAS OTR/L

Provider Business Mailing Address
First Line	:	843 N CENTER ST
Second Line	:
City	:	HICKORY
State	:	NC
Zip	:	28601-3751
Country	:	US
Telephone Number	:	410-693-8353
Fax Number	:

Provider Business Practice Location Address
First Line	:	4012 HICKORY BLVD
Second Line	:
City	:	GRANITE FALLS
State	:	NC
Zip	:	28630-8372
Country	:	US
Telephone Number	:	828-212-0256
Fax Number	:

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

Provider Enumeration Date	:	10/16/2018
Last Update Date	:	10/16/2018

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