Provider Demographics
NPI:1003675596
Name:COUSIN, MATTHEW THOMAS
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:THOMAS
Last Name:COUSIN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6144 APPLECREEK RD
Mailing Address - Street 2:
Mailing Address - City:SMITHVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44677-9720
Mailing Address - Country:US
Mailing Address - Phone:330-988-0046
Mailing Address - Fax:
Practice Address - Street 1:6144 APPLECREEK RD
Practice Address - Street 2:
Practice Address - City:SMITHVILLE
Practice Address - State:OH
Practice Address - Zip Code:44677-9720
Practice Address - Country:US
Practice Address - Phone:330-988-0046
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-18
Last Update Date:2024-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant