Provider Demographics
NPI:1295090561
Name:MATNEY, PAULA JEAN (OTA1155)
Entity type:Individual
Prefix:
First Name:PAULA
Middle Name:JEAN
Last Name:MATNEY
Suffix:
Gender:F
Credentials:OTA1155
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34426 PETTIBONE RD
Mailing Address - Street 2:
Mailing Address - City:SOLON
Mailing Address - State:OH
Mailing Address - Zip Code:44139-5020
Mailing Address - Country:US
Mailing Address - Phone:440-248-9799
Mailing Address - Fax:
Practice Address - Street 1:34426 PETTIBONE RD
Practice Address - Street 2:
Practice Address - City:SOLON
Practice Address - State:OH
Practice Address - Zip Code:44139-5020
Practice Address - Country:US
Practice Address - Phone:440-248-9799
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-11
Last Update Date:2012-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOTA1155225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist