Provider Demographics
NPI:1336271139
Name:MATTER, KORIN
Entity type:Individual
Prefix:
First Name:KORIN
Middle Name:
Last Name:MATTER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5325 GREENWOOD AVE
Mailing Address - Street 2:SUIE 201
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33407-2452
Mailing Address - Country:US
Mailing Address - Phone:561-422-9545
Mailing Address - Fax:561-881-0972
Practice Address - Street 1:5325 GREENWOOD AVE
Practice Address - Street 2:SUIE 201
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33407-2452
Practice Address - Country:US
Practice Address - Phone:561-422-9545
Practice Address - Fax:561-881-0972
Is Sole Proprietor?:No
Enumeration Date:2007-03-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL222Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist