Provider Demographics
NPI:1083769038
Name:MATTOON, NINA R (LMP)
Entity Type:Individual
Prefix:MS
First Name:NINA
Middle Name:R
Last Name:MATTOON
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:4123 SW KENYON ST
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98136-2332
Mailing Address - Country:US
Mailing Address - Phone:425-221-3236
Mailing Address - Fax:206-923-0093
Practice Address - Street 1:3435 CALIFORNIA AVE SW STE 100A
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98116-3371
Practice Address - Country:US
Practice Address - Phone:206-937-4777
Practice Address - Fax:206-923-0093
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-23
Last Update Date:2010-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00014101225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist