Individual
MRS. IDELLE ANN MATTHEWS
Active
Individual
MRS. IDELLE ANN MATTHEWS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Taxonomy
Speciality
Code
Description
License number
State
225XP0200X
Pediatric Occupational Therapist
Primary
—
—
235Z00000X
Speech-Language Pathologist
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200259560
—
OK
05
—
200560430
—
OK
05
—
200692960
—
OK
05
—
200860730
—
OK
05
—
200868730
—
OK
05
—
201153110
—
OK
Enumeration date
08/01/2023
Last updated
08/01/2023
Update your record
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