Provider Demographics
NPI:1700391653
Name:MATTSEN, CHISTOPHER (OTA)
Entity Type:Individual
Prefix:
First Name:CHISTOPHER
Middle Name:
Last Name:MATTSEN
Suffix:
Gender:M
Credentials:OTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25504 SE 247TH PL
Mailing Address - Street 2:
Mailing Address - City:RAVENSDALE
Mailing Address - State:WA
Mailing Address - Zip Code:98051-9675
Mailing Address - Country:US
Mailing Address - Phone:509-264-7189
Mailing Address - Fax:
Practice Address - Street 1:302 E 2ND AVE
Practice Address - Street 2:
Practice Address - City:ELLENSBURG
Practice Address - State:WA
Practice Address - Zip Code:98926-3316
Practice Address - Country:US
Practice Address - Phone:509-933-8677
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-12-13
Last Update Date:2017-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOC60815539224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant