Provider Demographics
NPI:1356775886
Name:STEADMAN, MATHEW RONALD (OT)
Entity type:Individual
Prefix:
First Name:MATHEW
Middle Name:RONALD
Last Name:STEADMAN
Suffix:
Gender:M
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1025 ROBERTA LN
Mailing Address - Street 2:
Mailing Address - City:SPARKS
Mailing Address - State:NV
Mailing Address - Zip Code:89431-1893
Mailing Address - Country:US
Mailing Address - Phone:775-825-4744
Mailing Address - Fax:775-351-1644
Practice Address - Street 1:1025 ROBERTA LN
Practice Address - Street 2:
Practice Address - City:SPARKS
Practice Address - State:NV
Practice Address - Zip Code:89431-1893
Practice Address - Country:US
Practice Address - Phone:775-825-4744
Practice Address - Fax:775-351-1644
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-03
Last Update Date:2013-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV13-0362225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVZZ225XP0200XMedicaid