Provider Demographics
NPI:1366085771
Name:PATRICK, MATILDA ANNA (OT)
Entity type:Individual
Prefix:MS
First Name:MATILDA
Middle Name:ANNA
Last Name:PATRICK
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:238 SEQUOYAH CIR
Mailing Address - Street 2:
Mailing Address - City:MORGANTON
Mailing Address - State:NC
Mailing Address - Zip Code:28655-6804
Mailing Address - Country:US
Mailing Address - Phone:828-413-3481
Mailing Address - Fax:
Practice Address - Street 1:238 SEQUOYAH CIR
Practice Address - Street 2:
Practice Address - City:MORGANTON
Practice Address - State:NC
Practice Address - Zip Code:28655-6804
Practice Address - Country:US
Practice Address - Phone:828-413-3481
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-18
Last Update Date:2019-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0429225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC049OtherOT LICENSE