Provider Demographics
NPI:1144503632
Name:ENZ, MATTHEW DREW (OTR/L)
Entity type:Individual
Prefix:MR
First Name:MATTHEW
Middle Name:DREW
Last Name:ENZ
Suffix:
Gender:M
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:402 ATRIUM PL
Mailing Address - Street 2:
Mailing Address - City:WINCHESTER
Mailing Address - State:KY
Mailing Address - Zip Code:40391-2062
Mailing Address - Country:US
Mailing Address - Phone:740-821-6335
Mailing Address - Fax:
Practice Address - Street 1:402 ATRIUM PL
Practice Address - Street 2:
Practice Address - City:WINCHESTER
Practice Address - State:KY
Practice Address - Zip Code:40391-2062
Practice Address - Country:US
Practice Address - Phone:740-821-6335
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-21
Last Update Date:2011-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV1553225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist