Provider Demographics
NPI:1689976631
Name:MATTIX, KRISTINE RENAE (COTA)
Entity Type:Individual
Prefix:
First Name:KRISTINE
Middle Name:RENAE
Last Name:MATTIX
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1060 BASALT CT
Mailing Address - Street 2:
Mailing Address - City:WINDSOR
Mailing Address - State:CO
Mailing Address - Zip Code:80550-5549
Mailing Address - Country:US
Mailing Address - Phone:970-674-9226
Mailing Address - Fax:
Practice Address - Street 1:1060 BASALT CT
Practice Address - Street 2:
Practice Address - City:WINDSOR
Practice Address - State:CO
Practice Address - Zip Code:80550-5549
Practice Address - Country:US
Practice Address - Phone:970-674-9226
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-24
Last Update Date:2010-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant