Provider Demographics
NPI:1831793918
Name:WITKOWSKI, MATTHEW J (COTA)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:J
Last Name:WITKOWSKI
Suffix:
Gender:M
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35605 BLANCH AVE
Mailing Address - Street 2:
Mailing Address - City:EASTLAKE
Mailing Address - State:OH
Mailing Address - Zip Code:44095-3105
Mailing Address - Country:US
Mailing Address - Phone:941-929-6370
Mailing Address - Fax:
Practice Address - Street 1:8668 DAY DR
Practice Address - Street 2:
Practice Address - City:PARMA
Practice Address - State:OH
Practice Address - Zip Code:44129-5692
Practice Address - Country:US
Practice Address - Phone:440-340-4000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-30
Last Update Date:2020-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH007308224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant