Provider Demographics
NPI:1215400155
Name:MATTOX, LORA LEE (CPC)
Entity Type:Individual
Prefix:
First Name:LORA
Middle Name:LEE
Last Name:MATTOX
Suffix:
Gender:F
Credentials:CPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1723 KRESKY AVE
Mailing Address - Street 2:
Mailing Address - City:CENTRALIA
Mailing Address - State:WA
Mailing Address - Zip Code:98531-8985
Mailing Address - Country:US
Mailing Address - Phone:360-559-6201
Mailing Address - Fax:360-807-4429
Practice Address - Street 1:1723 KRESKY AVE
Practice Address - Street 2:
Practice Address - City:CENTRALIA
Practice Address - State:WA
Practice Address - Zip Code:98531-8985
Practice Address - Country:US
Practice Address - Phone:360-559-6201
Practice Address - Fax:360-807-4429
Is Sole Proprietor?:No
Enumeration Date:2019-01-03
Last Update Date:2019-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACG60864636175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist