Provider Demographics
NPI:1922655406
Name:MATOS, JESSICA NICOLE (MS ATR)
Entity Type:Individual
Prefix:MS
First Name:JESSICA
Middle Name:NICOLE
Last Name:MATOS
Suffix:
Gender:F
Credentials:MS ATR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15851 SW 51ST ST
Mailing Address - Street 2:
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33027-4976
Mailing Address - Country:US
Mailing Address - Phone:407-595-3915
Mailing Address - Fax:
Practice Address - Street 1:3400 HUNTERS CREEK BLVD
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32837-7230
Practice Address - Country:US
Practice Address - Phone:407-650-3073
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-20
Last Update Date:2019-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL18-515221700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes221700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersArt Therapist