Provider Demographics
NPI:1578640389
Name:FRICK, MATTHEW (OT)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:
Last Name:FRICK
Suffix:
Gender:M
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 843384
Mailing Address - Street 2:MOORE ORTHOPAEDIC CLINIC, P.A.
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29203
Mailing Address - Country:US
Mailing Address - Phone:803-227-8008
Mailing Address - Fax:803-227-8038
Practice Address - Street 1:14 MEDICAL PARK SUITE 200
Practice Address - Street 2:MOORE ORTHOPAEDIC CLINIC, P.A.
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29203
Practice Address - Country:US
Practice Address - Phone:803-227-8000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2775225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC2775OtherOT LICENSE