Provider Demographics
NPI:1093925943
Name:MATSUBUCHI, KATHRYN MATALA (OT)
Entity Type:Individual
Prefix:MRS
First Name:KATHRYN
Middle Name:MATALA
Last Name:MATSUBUCHI
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3010 S SOUTHEAST BLVD STE G
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99223-3542
Mailing Address - Country:US
Mailing Address - Phone:509-532-0500
Mailing Address - Fax:509-532-8810
Practice Address - Street 1:3010 S SOUTHEAST BLVD STE G
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99223-3542
Practice Address - Country:US
Practice Address - Phone:509-532-0500
Practice Address - Fax:509-532-8810
Is Sole Proprietor?:No
Enumeration Date:2007-05-22
Last Update Date:2021-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOT00002727225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0351054OtherDEPT OF L&I
WA1056882Medicaid