Provider Demographics
NPI:1467796714
Name:MATTHEWS, JEANNE M (OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:JEANNE
Middle Name:M
Last Name:MATTHEWS
Suffix:
Gender:F
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 1:1236 W WOOSTER ST
Mailing Address - Street 2:SUITEC
Mailing Address - City:BOWLING GREEN
Mailing Address - State:OH
Mailing Address - Zip Code:43402-2790
Mailing Address - Country:US
Mailing Address - Phone:419-308-5622
Mailing Address - Fax:
Practice Address - Street 1:1236 W WOOSTER ST
Practice Address - Street 2:SUITE C
Practice Address - City:BOWLING GREEN
Practice Address - State:OH
Practice Address - Zip Code:43402-2790
Practice Address - Country:US
Practice Address - Phone:419-308-5622
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-26
Last Update Date:2012-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1483225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist