Provider Demographics
NPI:1053056564
Name:MATTHEWS, PAITYN NICOLE
Entity Type:Individual
Prefix:
First Name:PAITYN
Middle Name:NICOLE
Last Name:MATTHEWS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22163 COUNTY STREET 2700
Mailing Address - Street 2:
Mailing Address - City:GRACEMONT
Mailing Address - State:OK
Mailing Address - Zip Code:73042-9513
Mailing Address - Country:US
Mailing Address - Phone:405-519-5493
Mailing Address - Fax:
Practice Address - Street 1:200 NW 66TH ST STE 925
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73116-8227
Practice Address - Country:US
Practice Address - Phone:405-286-3749
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-29
Last Update Date:2022-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2150224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant