Provider Demographics
NPI:1518133370
Name:MATTHEWS, MONICA MONIQUE (OTR)
Entity Type:Individual
Prefix:MS
First Name:MONICA
Middle Name:MONIQUE
Last Name:MATTHEWS
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14951 BELLOWS FALLS LN APT 1112
Mailing Address - Street 2:
Mailing Address - City:HUMBLE
Mailing Address - State:TX
Mailing Address - Zip Code:77396-6094
Mailing Address - Country:US
Mailing Address - Phone:414-403-2080
Mailing Address - Fax:
Practice Address - Street 1:14951 BELLOWS FALLS LN APT 1112
Practice Address - Street 2:
Practice Address - City:HUMBLE
Practice Address - State:TX
Practice Address - Zip Code:77396-6094
Practice Address - Country:US
Practice Address - Phone:414-403-2080
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-01
Last Update Date:2023-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX112500225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI40899200Medicaid