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Individual

GWENDOLYN M MATUSZ

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
COTA

Contact information

Practice address
6040 LUTE RD, PORTAGE, IN 46368-5008
(219) 763-6858
(219) 763-4858
Mailing address
2003 CLAREMONT DR, LONG BEACH, IN 46360-1404
(219) 874-3551

Taxonomy

Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
32000822A
IN

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
32000822A
COTA
IN
Enumeration date
07/12/2007
Last updated
07/12/2007
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