Provider Demographics
NPI:1417232661
Name:ABLITZ, MATTIE (MOTR/L)
Entity Type:Individual
Prefix:
First Name:MATTIE
Middle Name:
Last Name:ABLITZ
Suffix:
Gender:F
Credentials:MOTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9216 HUNTING CT
Mailing Address - Street 2:
Mailing Address - City:MATTHEWS
Mailing Address - State:NC
Mailing Address - Zip Code:28105-6598
Mailing Address - Country:US
Mailing Address - Phone:540-222-0340
Mailing Address - Fax:
Practice Address - Street 1:9216 HUNTING CT
Practice Address - Street 2:
Practice Address - City:MATTHEWS
Practice Address - State:NC
Practice Address - Zip Code:28105-6598
Practice Address - Country:US
Practice Address - Phone:540-222-0340
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-19
Last Update Date:2021-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC5816225X00000X
NC10693225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty