Provider Demographics
NPI:1821578808
Name:FLANAGAN, MATTHEW (COTA)
Entity Type:Individual
Prefix:MR
First Name:MATTHEW
Middle Name:
Last Name:FLANAGAN
Suffix:
Gender:M
Credentials:COTA
Other - Prefix:MR
Other - First Name:MATTHEW
Other - Middle Name:
Other - Last Name:FLANAGAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:COTA
Mailing Address - Street 1:1750 E LEAGUE CITY PKWY APT 1126
Mailing Address - Street 2:
Mailing Address - City:LEAGUE CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77573-2698
Mailing Address - Country:US
Mailing Address - Phone:832-465-9342
Mailing Address - Fax:
Practice Address - Street 1:11800 ASTORIA BLVD
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77089-6041
Practice Address - Country:US
Practice Address - Phone:832-465-9342
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-18
Last Update Date:2018-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX208748224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX208748OtherTEXAS BOARD OF OCCUPATIONAL THERAPY EXAMINERS