Provider Demographics
NPI:1821784299
Name:DELAY, MATTHEW W (CPED)
Entity Type:Individual
Prefix:MR
First Name:MATTHEW
Middle Name:W
Last Name:DELAY
Suffix:
Gender:M
Credentials:CPED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2149 STUMBO RD
Mailing Address - Street 2:
Mailing Address - City:ONTARIO
Mailing Address - State:OH
Mailing Address - Zip Code:44906-1265
Mailing Address - Country:US
Mailing Address - Phone:419-512-9841
Mailing Address - Fax:419-775-5861
Practice Address - Street 1:2149 STUMBO RD
Practice Address - Street 2:
Practice Address - City:ONTARIO
Practice Address - State:OH
Practice Address - Zip Code:44906-1265
Practice Address - Country:US
Practice Address - Phone:419-512-9841
Practice Address - Fax:419-775-5861
Is Sole Proprietor?:No
Enumeration Date:2023-04-17
Last Update Date:2023-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHC22312222Z00000X
OHLO.00382222Z00000X
OHCPED1306224L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224L00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPedorthist
No222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotist