Active NPI
Idelle Ann Matthews
- Pediatric Occupational Therapist
- Shawnee, OK
National Provider Identifier
1689356511
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatric Occupational Therapist
- Practice address
- 3903 N Harrison St
Shawnee, OK 74804-1426 - Phone
- (405) 585-2971
- Fax
- (405) 585-2983
- NPI assigned
- Aug 1, 2023
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Speech-Language Pathologist | 235Z00000X | |||
| Pediatric Occupational Therapist | 225XP0200X | Primary |
Addresses
Primary practice location
3903 N Harrison St
Shawnee, OK 74804-1426
Mailing address
3903 N Harrison St
Shawnee, OK 74804-1426
Phone (405) 585-2971
Other identifiers 6
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 200692960 | Medicaid | OK | |
| 201153110 | Medicaid | OK | |
| 200560430 | Medicaid | OK | |
| 200259560 | Medicaid | OK | |
| 200860730 | Medicaid | OK | |
| 200868730 | Medicaid | OK |
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
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1690848000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1690848000000",
"number": "1689356511",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3903 N HARRISON ST",
"city": "SHAWNEE",
"state": "OK",
"postal_code": "748041426",
"telephone_number": "405-585-2971",
"fax_number": "405-585-2983"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3903 N HARRISON ST",
"city": "SHAWNEE",
"state": "OK",
"postal_code": "748041426",
"telephone_number": "405-585-2971",
"fax_number": "405-585-2983"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MATTHEWS",
"first_name": "IDELLE",
"middle_name": "ANN",
"name_prefix": "Mrs.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2023-08-01",
"last_updated": "2023-08-01",
"certification_date": "2023-08-01",
"status": "A"
},
"taxonomies": [
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": null,
"license": null,
"primary": false
},
{
"code": "225XP0200X",
"taxonomy_group": "",
"desc": "Occupational Therapist, Pediatrics",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "200692960",
"state": "OK"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "201153110",
"state": "OK"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "200560430",
"state": "OK"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "200259560",
"state": "OK"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "200860730",
"state": "OK"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "200868730",
"state": "OK"
}
],
"endpoints": [],
"other_names": []
}Other providers in Shawnee, OK
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 1, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.