Provider Demographics
NPI:1689202889
Name:MATTHEWS, JAMIE L (OTR)
Entity type:Individual
Prefix:
First Name:JAMIE
Middle Name:L
Last Name:MATTHEWS
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:518 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MECHANICSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17055-3243
Mailing Address - Country:US
Mailing Address - Phone:443-690-6853
Mailing Address - Fax:
Practice Address - Street 1:518 W MAIN ST
Practice Address - Street 2:
Practice Address - City:MECHANICSBURG
Practice Address - State:PA
Practice Address - Zip Code:17055-3243
Practice Address - Country:US
Practice Address - Phone:443-690-6853
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-01
Last Update Date:2020-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOC016875225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist