Provider Demographics
NPI:1740854074
Name:NOSSER, MATTHEW THOMAS II (AM, ULCM)
Entity type:Individual
Prefix:MR
First Name:MATTHEW
Middle Name:THOMAS
Last Name:NOSSER
Suffix:II
Gender:M
Credentials:AM, ULCM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5017 WARREN RD
Mailing Address - Street 2:
Mailing Address - City:IMPERIAL
Mailing Address - State:MO
Mailing Address - Zip Code:63052
Mailing Address - Country:US
Mailing Address - Phone:314-701-6390
Mailing Address - Fax:
Practice Address - Street 1:5017 WARREN RD
Practice Address - Street 2:
Practice Address - City:IMPERIAL
Practice Address - State:MO
Practice Address - Zip Code:63052
Practice Address - Country:US
Practice Address - Phone:314-701-6390
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-20
Last Update Date:2021-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XM0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistMental Health