Individual
MATTHEW BLACK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
OTD
Contact information
Practice address
5241 23RD INFANTRY REGIMENT ST BLDG 3410, FORT BENNING, GA 31905-5922
(541) 226-7995
Mailing address
6600 VAN AALST BLVD, FORT BENNING, GA 31905-2102
(541) 226-7995
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
OT009562
GA
Other
Enumeration date
09/26/2023
Last updated
06/06/2025
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