Provider Demographics
NPI:1578241543
Name:MATACHUN, CODY ALFRED
Entity Type:Individual
Prefix:
First Name:CODY
Middle Name:ALFRED
Last Name:MATACHUN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 BYRON AVE
Mailing Address - Street 2:
Mailing Address - City:METHUEN
Mailing Address - State:MA
Mailing Address - Zip Code:01844-4862
Mailing Address - Country:US
Mailing Address - Phone:978-835-7301
Mailing Address - Fax:
Practice Address - Street 1:9 BYRON AVE
Practice Address - Street 2:
Practice Address - City:METHUEN
Practice Address - State:MA
Practice Address - Zip Code:01844-4862
Practice Address - Country:US
Practice Address - Phone:978-835-7301
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-10
Last Update Date:2023-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer