Provider Demographics
NPI:1730772062
Name:BROCIOUS, MATTHEW (OTR)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:
Last Name:BROCIOUS
Suffix:
Gender:M
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5315 MARKET ST
Mailing Address - Street 2:
Mailing Address - City:YOUNGSTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44512-2222
Mailing Address - Country:US
Mailing Address - Phone:330-881-7966
Mailing Address - Fax:
Practice Address - Street 1:5315 MARKET ST
Practice Address - Street 2:
Practice Address - City:YOUNGSTOWN
Practice Address - State:OH
Practice Address - Zip Code:44512-2222
Practice Address - Country:US
Practice Address - Phone:330-881-7966
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-17
Last Update Date:2021-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist