Provider Demographics
NPI:1174022859
Name:DAVID R MATOS OCCUPATIONAL THERAPY SERVICES LLC
Entity Type:Organization
Organization Name:DAVID R MATOS OCCUPATIONAL THERAPY SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OCCUPATIONAL THERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:ROLANDO
Authorized Official - Last Name:MATOS
Authorized Official - Suffix:
Authorized Official - Credentials:MOT, OTR/L
Authorized Official - Phone:754-224-6727
Mailing Address - Street 1:12049 SW KNIGHTSBRIDGE LN
Mailing Address - Street 2:
Mailing Address - City:PORT SAINT LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34987-2731
Mailing Address - Country:US
Mailing Address - Phone:754-224-6727
Mailing Address - Fax:
Practice Address - Street 1:12049 SW KNIGHTSBRIDGE LN
Practice Address - Street 2:
Practice Address - City:PORT SAINT LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34987-2731
Practice Address - Country:US
Practice Address - Phone:754-224-6727
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-07
Last Update Date:2018-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT18631225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty