Provider Demographics
NPI:1467697581
Name:MATHER, MICHELLE VALLI (CMT)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:VALLI
Last Name:MATHER
Suffix:
Gender:F
Credentials:CMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1398
Mailing Address - Street 2:
Mailing Address - City:MAMMOTH LAKES
Mailing Address - State:CA
Mailing Address - Zip Code:93546-1398
Mailing Address - Country:US
Mailing Address - Phone:760-709-1422
Mailing Address - Fax:
Practice Address - Street 1:645 OLD MAMMOTH ROAD
Practice Address - Street 2:SUITE 1
Practice Address - City:MAMMOTH LAKES
Practice Address - State:CA
Practice Address - Zip Code:93546
Practice Address - Country:US
Practice Address - Phone:760-709-1422
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-03
Last Update Date:2008-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist