Active NPI
Tia Lanaye Mattox, OTR/L
- Occupational Therapist
- Weston, FL
National Provider Identifier
1316688583
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapist
- License
- OT22937
- Practice address
- 2833 Executive Park Dr
Weston, FL 33331-3650 - Phone
- (954) 353-8777
- NPI assigned
- Apr 4, 2022
- Sex
- Female
- 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 Therapist | 225X00000X | OT22937 | FL | Primary |
Addresses
Primary practice location
2833 Executive Park Dr
Weston, FL 33331-3650
Mailing address
1438 NW 80TH Way
Plantation, FL 33322-5772
Phone (954) 348-8664
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 |
|---|---|---|---|
| OT22937 | FL | MD | Occupational Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1649030400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1649462400000",
"number": "1316688583",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1438 NW 80TH WAY",
"city": "PLANTATION",
"state": "FL",
"postal_code": "333225772",
"telephone_number": "954-348-8664"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2833 EXECUTIVE PARK DR",
"city": "WESTON",
"state": "FL",
"postal_code": "333313650",
"telephone_number": "954-353-8777"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MATTOX",
"first_name": "TIA",
"middle_name": "LANAYE",
"name_prefix": "Dr.",
"credential": "OTR/L",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2022-04-04",
"last_updated": "2022-04-09",
"certification_date": "2022-04-09",
"status": "A"
},
"taxonomies": [
{
"code": "225X00000X",
"taxonomy_group": "",
"desc": "Occupational Therapist",
"state": "FL",
"license": "OT22937",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Weston, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 9, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.