Provider Demographics
NPI:1942448204
Name:DONG, MATTHEW DAVID (OTR/L)
Entity Type:Individual
Prefix:MR
First Name:MATTHEW
Middle Name:DAVID
Last Name:DONG
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 1:40 RAYMOND AVE
Mailing Address - Street 2:UNIT C
Mailing Address - City:SOMERVILLE
Mailing Address - State:MA
Mailing Address - Zip Code:02144-1210
Mailing Address - Country:US
Mailing Address - Phone:617-480-7577
Mailing Address - Fax:
Practice Address - Street 1:12 CHURCH ST
Practice Address - Street 2:
Practice Address - City:BELMONT
Practice Address - State:MA
Practice Address - Zip Code:02478-4901
Practice Address - Country:US
Practice Address - Phone:617-484-0193
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-25
Last Update Date:2009-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA7723225XM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XM0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistMental Health