Provider Demographics
NPI:1629220918
Name:WOODRUFF, MATTHEW D (MOTR/L)
Entity Type:Individual
Prefix:MR
First Name:MATTHEW
Middle Name:D
Last Name:WOODRUFF
Suffix:
Gender:M
Credentials:MOTR/L
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:3015 E MAGIC VIEW DR
Mailing Address - Street 2:STE 100
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83642-3750
Mailing Address - Country:US
Mailing Address - Phone:208-853-6220
Mailing Address - Fax:208-853-0554
Practice Address - Street 1:5521 W STATE ST
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83703-3337
Practice Address - Country:US
Practice Address - Phone:208-853-6220
Practice Address - Fax:208-853-0554
Is Sole Proprietor?:No
Enumeration Date:2008-10-17
Last Update Date:2018-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDOT-765225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist