Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224Z00000X | Occupational Therapy Assistant | OTA006657 | OH |
NPI | 1013414341 |
---|---|
Provider Name | Matthew Clinic Deangelis |
First Address | Akron, OH 44303-1465 |
Second Address | Akron, OH 44303-1465 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/04/2018 |
Last Update Date | 12/04/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
OTA006657 | OTA (01) | OH |