Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224Z00000X | Occupational Therapy Assistant |
NPI | 1023609187 |
---|---|
Provider Name | Marcella Mattox |
First Address | Solon, OH 44139-1973 |
Second Address | Solon, OH 44139-1973 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/02/2021 |
Last Update Date | 01/02/2021 |