Provider Demographics
NPI:1558074583
Name:LEWELLIS, MATTHEW (OTR/L)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:
Last Name:LEWELLIS
Suffix:
Gender:M
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 1:2630 WOODLAND RD
Mailing Address - Street 2:
Mailing Address - City:ABINGTON
Mailing Address - State:PA
Mailing Address - Zip Code:19001-3013
Mailing Address - Country:US
Mailing Address - Phone:215-884-6776
Mailing Address - Fax:
Practice Address - Street 1:2630 WOODLAND RD
Practice Address - Street 2:
Practice Address - City:ABINGTON
Practice Address - State:PA
Practice Address - Zip Code:19001-3013
Practice Address - Country:US
Practice Address - Phone:215-884-6776
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-04
Last Update Date:2023-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOC012580225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist