Provider Demographics
NPI:1134348352
Name:MATHENA, CYNTHIA K
Entity type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:K
Last Name:MATHENA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 SOUTHPARK BLVD
Mailing Address - Street 2:SUITE B201
Mailing Address - City:SAINT AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32086-5191
Mailing Address - Country:US
Mailing Address - Phone:904-824-1636
Mailing Address - Fax:904-824-7488
Practice Address - Street 1:105 SOUTHPARK BLVD
Practice Address - Street 2:SUITE B201
Practice Address - City:SAINT AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32086-5191
Practice Address - Country:US
Practice Address - Phone:904-824-1636
Practice Address - Fax:904-824-7488
Is Sole Proprietor?:No
Enumeration Date:2007-04-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT0008919225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist