Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225X00000X | Occupational Therapist | 08500 | MD |
Y | 225XM0800X | Mental Health |
NPI | 1649764556 |
---|---|
Provider Name | Kenneth Matthews |
First Address | Bethesda, MD 20889-0004 |
Second Address | Bethesda, MD 20889-0004 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/06/2018 |
Last Update Date | 15/06/2018 |