Provider Demographics
NPI:1326399288
Name:MATTHEWS, MAUREEN MICHELE (OTL)
Entity Type:Individual
Prefix:
First Name:MAUREEN
Middle Name:MICHELE
Last Name:MATTHEWS
Suffix:
Gender:F
Credentials:OTL
Other - Prefix:
Other - First Name:MAUREEN
Other - Middle Name:MICHELE
Other - Last Name:EARLY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTL
Mailing Address - Street 1:363 CLOVERDALE LN
Mailing Address - Street 2:
Mailing Address - City:CAMPBELL
Mailing Address - State:CA
Mailing Address - Zip Code:95008-1701
Mailing Address - Country:US
Mailing Address - Phone:408-410-9752
Mailing Address - Fax:
Practice Address - Street 1:751 S BASCOM AVE
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95128-2604
Practice Address - Country:US
Practice Address - Phone:408-885-5605
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-01
Last Update Date:2012-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOT4138225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist