Provider Demographics
NPI:1356995955
Name:MATTIUZ, ERIKA CHARLOTTE (MS,OTR/L)
Entity type:Individual
Prefix:
First Name:ERIKA
Middle Name:CHARLOTTE
Last Name:MATTIUZ
Suffix:
Gender:F
Credentials:MS,OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 KIMBERLEY CIR
Mailing Address - Street 2:
Mailing Address - City:OAK BROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60523-1719
Mailing Address - Country:US
Mailing Address - Phone:708-259-4800
Mailing Address - Fax:
Practice Address - Street 1:8 KIMBERLEY CIR
Practice Address - Street 2:
Practice Address - City:OAK BROOK
Practice Address - State:IL
Practice Address - Zip Code:60523-1719
Practice Address - Country:US
Practice Address - Phone:708-259-4800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-31
Last Update Date:2019-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL056.004930225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty