Active NPI
Matthew Wayne Resener, COTA
- Occupational Therapy Assistant
- Worcester, MA
National Provider Identifier
1194295618
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapy Assistant
- License
- 4102
- Practice address
- 63 Malden St
Worcester, MA 01606-1005 - Phone
- (508) 615-2512
- NPI assigned
- Nov 27, 2018
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Occupational Therapy Assistant | 224Z00000X | 4102 | MA | Primary |
Addresses
Primary practice location
63 Malden St
Worcester, MA 01606-1005
Mailing address
63 Malden St
Worcester, MA 01606-1005
Phone (508) 615-2512
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| S33872023 | Other | MA | DRIVER LICENSE |
Other names 1
- Matthew Wayne Resener
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 4102 | MA | MD | Mental Health Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1543276800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1543276800000",
"number": "1194295618",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "63 MALDEN ST",
"city": "WORCESTER",
"state": "MA",
"postal_code": "016061005",
"telephone_number": "508-615-2512"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "63 MALDEN ST",
"city": "WORCESTER",
"state": "MA",
"postal_code": "016061005",
"telephone_number": "508-615-2512"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RESENER",
"first_name": "MATTHEW",
"middle_name": "WAYNE",
"credential": "COTA",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2018-11-27",
"last_updated": "2018-11-27",
"status": "A"
},
"taxonomies": [
{
"code": "224Z00000X",
"taxonomy_group": "",
"desc": "Occupational Therapy Assistant",
"state": "MA",
"license": "4102",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "DRIVER LICENSE",
"identifier": "S33872023",
"state": "MA"
}
],
"endpoints": [],
"other_names": [
{
"first_name": "MATTHEW",
"last_name": "RESENER",
"middle_name": "WAYNE",
"credential": "COTA",
"code": "2",
"type": "Professional Name"
}
]
}Other providers in Worcester, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 27, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.