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NPI Code Detail

MEDICARE: MATTHEW BRIGMAN

MEDICARE: MATTHEW BRIGMAN
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 Therapist056011035IL

General Provider Information

NPI Number : 1891278065
Entity Type Code : Individual
Provider Name (Legal Business Name) : MATTHEW BRIGMAN
Provider Business Mailing Address
First Line : 100 ROSEWOOD VILLAGE DR
Second Line :
City : SWANSEA
State : IL
Zip : 62226-2301
Country : US
Telephone Number : 618-420-0981
Fax Number :
Provider Business Practice Location Address
First Line : 100 ROSEWOOD VILLAGE DR
Second Line :
City : SWANSEA
State : IL
Zip : 62226-2301
Country : US
Telephone Number : 618-420-0981
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/12/2018
Last Update Date : 09/12/2018

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