Provider Demographics
NPI:1730430919
Name:O'REILLY, MATTHEW (COF)
Entity type:Individual
Prefix:MR
First Name:MATTHEW
Middle Name:
Last Name:O'REILLY
Suffix:
Gender:M
Credentials:COF
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13 PINEHURST MNR APT B
Mailing Address - Street 2:
Mailing Address - City:PINEHURST
Mailing Address - State:NC
Mailing Address - Zip Code:28374-8152
Mailing Address - Country:US
Mailing Address - Phone:910-603-1206
Mailing Address - Fax:910-295-2996
Practice Address - Street 1:13 PINEHURST MNR APT B
Practice Address - Street 2:
Practice Address - City:PINEHURST
Practice Address - State:NC
Practice Address - Zip Code:28374-8152
Practice Address - Country:US
Practice Address - Phone:910-603-1206
Practice Address - Fax:910-295-2996
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-27
Last Update Date:2012-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier