Provider Demographics
NPI:1952102360
Name:MATHEW, TEENA MARIAM (MSOT, OTR/L)
Entity type:Individual
Prefix:
First Name:TEENA
Middle Name:MARIAM
Last Name:MATHEW
Suffix:
Gender:F
Credentials:MSOT, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1100 CHANDLER ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19111-2613
Mailing Address - Country:US
Mailing Address - Phone:267-423-0875
Mailing Address - Fax:
Practice Address - Street 1:1920 SWARTHMORE AVE STE 5
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08701-4780
Practice Address - Country:US
Practice Address - Phone:215-839-6144
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-21
Last Update Date:2025-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOC020647225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist