Provider Demographics
NPI:1477124451
Name:MATHISON, REBECCA JEAN (MSOT)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:JEAN
Last Name:MATHISON
Suffix:
Gender:F
Credentials:MSOT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1025 2ND ST APT 11
Mailing Address - Street 2:
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90403-3643
Mailing Address - Country:US
Mailing Address - Phone:828-460-4787
Mailing Address - Fax:
Practice Address - Street 1:21515 HAWTHORNE BLVD STE G100
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90503-6501
Practice Address - Country:US
Practice Address - Phone:424-571-2618
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-09
Last Update Date:2023-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225X00000X
NC14263225X00000X
CA23908225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist