Provider Demographics
NPI:1598523078
Name:MEDICK, MATTHEW G (OTD, OTR/L)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:G
Last Name:MEDICK
Suffix:
Gender:M
Credentials:OTD, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:216 S OAK PARK AVE APT 4
Mailing Address - Street 2:
Mailing Address - City:OAK PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60302-3242
Mailing Address - Country:US
Mailing Address - Phone:630-890-9403
Mailing Address - Fax:
Practice Address - Street 1:216 S OAK PARK AVE APT 4
Practice Address - Street 2:
Practice Address - City:OAK PARK
Practice Address - State:IL
Practice Address - Zip Code:60302-3242
Practice Address - Country:US
Practice Address - Phone:630-890-9403
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-11
Last Update Date:2024-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL056.014510225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist