Individual
MR. MATTHEW JOHN WARREN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OTR/L
Contact information
Practice address
179 COMBS ST, SPARTA, NC 28675-8429
(336) 372-1634
Mailing address
5315 ARQUILLA DR, RICHTON PARK, IL 60471-1521
(708) 802-4581
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
056010462
IL
225X00000X
Occupational Therapist
10918
NC
Other
Enumeration date
12/31/2015
Last updated
04/27/2018
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