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Individual

ANGELA D MATTHIESSEN

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
OT

Contact information

Practice address
402 DOGWOOD DR S, MURRELLS INLET, SC 29576-8025
(770) 330-1061
Mailing address
402 DOGWOOD DR S, MURRELLS INLET, SC 29576-8025
(770) 330-1061

Taxonomy

Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
5534
SC
225X00000X
Occupational Therapist
OY002294
GA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
008454699
DRIVERS LICENSE
SC
Enumeration date
10/09/2009
Last updated
02/27/2020
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