Provider Demographics
NPI:1407674070
Name:BARBER, MATTHEW J ANTHONY (BS)
Entity type:Individual
Prefix:MR
First Name:MATTHEW
Middle Name:J ANTHONY
Last Name:BARBER
Suffix:
Gender:M
Credentials:BS
Other - Prefix:MR
Other - First Name:MATTHEW
Other - Middle Name:J
Other - Last Name:BARBER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:BD
Mailing Address - Street 1:206 W 5TH ST
Mailing Address - Street 2:
Mailing Address - City:METROPOLIS
Mailing Address - State:IL
Mailing Address - Zip Code:62960-1810
Mailing Address - Country:US
Mailing Address - Phone:800-851-1251
Mailing Address - Fax:
Practice Address - Street 1:206 W 5TH ST
Practice Address - Street 2:
Practice Address - City:METROPOLIS
Practice Address - State:IL
Practice Address - Zip Code:62960-1810
Practice Address - Country:US
Practice Address - Phone:800-851-1251
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-01
Last Update Date:2024-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL225XM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XM0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistMental Health