Provider Demographics
NPI:1376067520
Name:MATOS, DAVID (MOT, OTR/L)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:MATOS
Suffix:
Gender:M
Credentials:MOT, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8881 SW MONTOVA WAY
Mailing Address - Street 2:
Mailing Address - City:PORT ST LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34987-8708
Mailing Address - Country:US
Mailing Address - Phone:772-521-5238
Mailing Address - Fax:772-673-8444
Practice Address - Street 1:8881 SW MONTOVA WAY
Practice Address - Street 2:
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34987-8708
Practice Address - Country:US
Practice Address - Phone:772-521-5238
Practice Address - Fax:772-673-8444
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-31
Last Update Date:2024-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT18631225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist