MEDICARE: PATRICIA L MATZKE MS, OTR

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	225XP0200X	Pediatric Occupational Therapist	101001	TX

General Provider Information

NPI Number	:	1922139922
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PATRICIA L MATZKE MS, OTR

Provider Business Mailing Address
First Line	:	1516 COPPER CREEK DR
Second Line	:
City	:	PLANO
State	:	TX
Zip	:	75075-2214
Country	:	US
Telephone Number	:	972-596-6192
Fax Number	:

Provider Business Practice Location Address
First Line	:	4011 W PLANO PKWY
Second Line	:	SUITE 118
City	:	PLANO
State	:	TX
Zip	:	75093-5629
Country	:	US
Telephone Number	:	972-596-6192
Fax Number	:

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

Provider Enumeration Date	:	03/08/2007
Last Update Date	:	07/08/2007

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