Provider Demographics
NPI:1992864631
Name:MATYAS, ANN M (OTR CHT LA-C)
Entity type:Individual
Prefix:
First Name:ANN
Middle Name:M
Last Name:MATYAS
Suffix:
Gender:F
Credentials:OTR CHT LA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2501 W BELTLINE HWY
Mailing Address - Street 2:SUITE 601
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53713-2318
Mailing Address - Country:US
Mailing Address - Phone:608-294-6464
Mailing Address - Fax:608-288-6496
Practice Address - Street 1:2501 W BELTLINE HWY
Practice Address - Street 2:SUITE 601
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53713-2318
Practice Address - Country:US
Practice Address - Phone:608-294-6464
Practice Address - Fax:608-288-6496
Is Sole Proprietor?:No
Enumeration Date:2006-12-08
Last Update Date:2014-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2728-026225XH1200X
WI2728-26225X00000X
WI635-55171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand
No171100000XOther Service ProvidersAcupuncturist