Provider Demographics
NPI:1518681675
Name:MATHENY, KRISTEN 3042855500
Entity Type:Individual
Prefix:
First Name:KRISTEN
Middle Name:3042855500
Last Name:MATHENY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:511 BURROUGHS ST
Mailing Address - Street 2:
Mailing Address - City:MORGANTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:26505-0307
Mailing Address - Country:US
Mailing Address - Phone:304-285-5500
Mailing Address - Fax:
Practice Address - Street 1:206 N MOSBY AVE
Practice Address - Street 2:
Practice Address - City:LITTLETON
Practice Address - State:NC
Practice Address - Zip Code:27850-7782
Practice Address - Country:US
Practice Address - Phone:252-319-5900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-03
Last Update Date:2023-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0119009734225X00000X
WV2220225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist