Provider Demographics
NPI:1801541065
Name:BARRY, MATTHEW (COTA)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:
Last Name:BARRY
Suffix:
Gender:M
Credentials:COTA
Other - Prefix:
Other - First Name:MATT
Other - Middle Name:
Other - Last Name:BARRY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:8848 RED OAK BLVD STE AA
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28217-5595
Mailing Address - Country:US
Mailing Address - Phone:980-422-5887
Mailing Address - Fax:
Practice Address - Street 1:8848 RED OAK BLVD STE AA
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28217-5595
Practice Address - Country:US
Practice Address - Phone:980-422-5887
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-16
Last Update Date:2022-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC14651224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant