Provider Demographics
NPI:1326308560
Name:MATTHEWS, LISA SUNDIUS (OTR)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:SUNDIUS
Last Name:MATTHEWS
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29 SHADYLAWN DR
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:NJ
Mailing Address - Zip Code:07940-1011
Mailing Address - Country:US
Mailing Address - Phone:973-966-1924
Mailing Address - Fax:
Practice Address - Street 1:14 MAIN ST STE 206
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:NJ
Practice Address - Zip Code:07940-1818
Practice Address - Country:US
Practice Address - Phone:973-966-5577
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-22
Last Update Date:2012-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ46TR00060900225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist