Provider Demographics
NPI:1184422495
Name:PEVERLY, MATTHEW PAUL (OT)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:PAUL
Last Name:PEVERLY
Suffix:
Gender:
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 BUSHY HILL RD
Mailing Address - Street 2:
Mailing Address - City:GRANBY
Mailing Address - State:CT
Mailing Address - Zip Code:06035-1622
Mailing Address - Country:US
Mailing Address - Phone:405-534-0795
Mailing Address - Fax:
Practice Address - Street 1:275 STEELE RD
Practice Address - Street 2:
Practice Address - City:WEST HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06117-2716
Practice Address - Country:US
Practice Address - Phone:860-920-6319
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-04
Last Update Date:2025-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT6483225XG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XG0600XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGerontology