Provider Demographics
NPI:1598704942
Name:MATHIVHA, HARRY TSHIFHIWA (OTR/L)
Entity Type:Individual
Prefix:MR
First Name:HARRY
Middle Name:TSHIFHIWA
Last Name:MATHIVHA
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 1:103 ARBORGATE DR
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:OH
Mailing Address - Zip Code:45750-9224
Mailing Address - Country:US
Mailing Address - Phone:740-374-5049
Mailing Address - Fax:740-374-5049
Practice Address - Street 1:985 E MARIETTA RD NW
Practice Address - Street 2:
Practice Address - City:MC CONNELSVILLE
Practice Address - State:OH
Practice Address - Zip Code:43756-9768
Practice Address - Country:US
Practice Address - Phone:740-962-2152
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-04
Last Update Date:2008-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOT. 003354225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH4190141Medicare PIN