Provider Demographics
NPI:1518045459
Name:MATUKAITIS, SABRINA ANNE (MSOTRL)
Entity Type:Individual
Prefix:
First Name:SABRINA
Middle Name:ANNE
Last Name:MATUKAITIS
Suffix:
Gender:F
Credentials:MSOTRL
Other - Prefix:
Other - First Name:SABRINA
Other - Middle Name:ANNE
Other - Last Name:KOEBERLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSOTRL
Mailing Address - Street 1:1400 BLACKHORSE HILL RD
Mailing Address - Street 2:
Mailing Address - City:COATESVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:19320-2040
Mailing Address - Country:US
Mailing Address - Phone:610-384-7711
Mailing Address - Fax:
Practice Address - Street 1:1400 BLACKHORSE HILL RD
Practice Address - Street 2:
Practice Address - City:COATESVILLE
Practice Address - State:PA
Practice Address - Zip Code:19320-2040
Practice Address - Country:US
Practice Address - Phone:610-384-7711
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOC010274225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist