Provider Demographics
NPI:1497253199
Name:PLEN, MATTHEW (OTR/L, DOR)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:
Last Name:PLEN
Suffix:
Gender:M
Credentials:OTR/L, DOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1500 MOUNT VERNON ST APT 3R
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19130-3403
Mailing Address - Country:US
Mailing Address - Phone:860-597-3274
Mailing Address - Fax:
Practice Address - Street 1:2 FRANKLIN TOWN BLVD
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19103-1238
Practice Address - Country:US
Practice Address - Phone:860-597-3274
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-28
Last Update Date:2018-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0019XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPhysical Rehabilitation