Active NPI
Matthew McIntyre, MOT
- Occupational Therapist
- Hermantown, MN
National Provider Identifier
1821652405
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapist
- License
- 105959
- Practice address
- 4195 Westberg Rd
Hermantown, MN 55811-2950 - Phone
- (218) 216-9921
- NPI assigned
- Apr 29, 2019
- Sex
- Male
- Sole proprietor
- No
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 | 105959 | MN | Primary |
Addresses
Primary practice location
4195 Westberg Rd
Hermantown, MN 55811-2950
Mailing address
2965 E Tarpon Dr Ste 150
Meridian, ID 83642-9007
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)
- Enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1556496000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1556496000000",
"number": "1821652405",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2965 E TARPON DR STE 150",
"city": "MERIDIAN",
"state": "ID",
"postal_code": "836429007"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4195 WESTBERG RD",
"city": "HERMANTOWN",
"state": "MN",
"postal_code": "558112950",
"telephone_number": "218-216-9921"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MCINTYRE",
"first_name": "MATTHEW",
"credential": "MOT",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2019-04-29",
"last_updated": "2019-04-29",
"status": "A"
},
"taxonomies": [
{
"code": "225X00000X",
"taxonomy_group": "",
"desc": "Occupational Therapist",
"state": "MN",
"license": "105959",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Hermantown, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 29, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.