Provider Demographics
NPI:1457707549
Name:THOMAS, MATTHEW (OTR/L)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:
Last Name:THOMAS
Suffix:
Gender:M
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7614 MANHATTAN AVE
Mailing Address - Street 2:
Mailing Address - City:PARMA
Mailing Address - State:OH
Mailing Address - Zip Code:44129-1439
Mailing Address - Country:US
Mailing Address - Phone:216-401-7137
Mailing Address - Fax:
Practice Address - Street 1:7614 MANHATTAN AVE
Practice Address - Street 2:
Practice Address - City:PARMA
Practice Address - State:OH
Practice Address - Zip Code:44129-1439
Practice Address - Country:US
Practice Address - Phone:216-401-7137
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-05-09
Last Update Date:2016-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOT.009250225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist