Provider Demographics
NPI:1124668413
Name:BOEPPLE MATTAWAY, BEATRICE (ERYT500)
Entity type:Individual
Prefix:MRS
First Name:BEATRICE
Middle Name:
Last Name:BOEPPLE MATTAWAY
Suffix:
Gender:F
Credentials:ERYT500
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 WHISPERING CT
Mailing Address - Street 2:
Mailing Address - City:BARDONIA
Mailing Address - State:NY
Mailing Address - Zip Code:10954-1624
Mailing Address - Country:US
Mailing Address - Phone:914-588-4066
Mailing Address - Fax:
Practice Address - Street 1:17 WHISPERING CT
Practice Address - Street 2:
Practice Address - City:BARDONIA
Practice Address - State:NY
Practice Address - Zip Code:10954-1624
Practice Address - Country:US
Practice Address - Phone:914-588-4066
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-14
Last Update Date:2020-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer