Provider Demographics
NPI:1083669212
Name:PRESS, MATTHEW LAWRENCE (OTR/L)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:LAWRENCE
Last Name:PRESS
Suffix:
Gender:M
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5641 W WOOD ST
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85043-6324
Mailing Address - Country:US
Mailing Address - Phone:602-283-4556
Mailing Address - Fax:
Practice Address - Street 1:5641 W WOOD ST
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85043-6324
Practice Address - Country:US
Practice Address - Phone:602-283-4556
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-24
Last Update Date:2007-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3880225X00000X
FLOT9283225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist