Provider Demographics
NPI:1730534108
Name:MATOS, EMILYS
Entity type:Individual
Prefix:
First Name:EMILYS
Middle Name:
Last Name:MATOS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3524 NE 19TH AVE
Mailing Address - Street 2:
Mailing Address - City:CAPE CORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33909-3112
Mailing Address - Country:US
Mailing Address - Phone:239-464-1566
Mailing Address - Fax:
Practice Address - Street 1:CARR 31 KM 22.4
Practice Address - Street 2:
Practice Address - City:JUNCOS
Practice Address - State:PR
Practice Address - Zip Code:00777
Practice Address - Country:US
Practice Address - Phone:787-679-6569
Practice Address - Fax:787-734-1633
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-04
Last Update Date:2025-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1914-1224Z00000X
FL106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR1914-1OtherOCUPATIONAL THERAPY