Individual
MATTHEW WAYNE RESENER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
COTA
Contact information
Practice address
63 MALDEN ST, WORCESTER, MA 01606-1005
(508) 615-2512
Mailing address
63 MALDEN ST, WORCESTER, MA 01606-1005
(508) 615-2512
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
4102
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
S33872023
DRIVER LICENSE
MA
Enumeration date
11/27/2018
Last updated
11/27/2018
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