Provider Demographics
NPI:1013031897
Name:ARTEMAN, MARIA MELANIE MATTA (PT)
Entity Type:Individual
Prefix:
First Name:MARIA MELANIE
Middle Name:MATTA
Last Name:ARTEMAN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:MARIA MELANIE
Other - Middle Name:JACINTO
Other - Last Name:MATTA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:236 S OKLAHOMA AVE
Mailing Address - Street 2:
Mailing Address - City:MORTON
Mailing Address - State:IL
Mailing Address - Zip Code:61550-9077
Mailing Address - Country:US
Mailing Address - Phone:718-704-4447
Mailing Address - Fax:
Practice Address - Street 1:518 W ROMEO B GARRETT AVE
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61605-2319
Practice Address - Country:US
Practice Address - Phone:718-704-4447
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-19
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070014689171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor