Provider Demographics
NPI:1790492130
Name:LICHTER, MATTHEW KARL (OTR/L)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:KARL
Last Name:LICHTER
Suffix:
Gender:M
Credentials:OTR/L
Other - Prefix:
Other - First Name:MATTHEW
Other - Middle Name:
Other - Last Name:LICHTER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OTR/L
Mailing Address - Street 1:179 DIECKMAN RD
Mailing Address - Street 2:
Mailing Address - City:CHEHALIS
Mailing Address - State:WA
Mailing Address - Zip Code:98532-9614
Mailing Address - Country:US
Mailing Address - Phone:360-748-3384
Mailing Address - Fax:360-748-8360
Practice Address - Street 1:179 DIECKMAN RD
Practice Address - Street 2:
Practice Address - City:CHEHALIS
Practice Address - State:WA
Practice Address - Zip Code:98532-9614
Practice Address - Country:US
Practice Address - Phone:360-748-3384
Practice Address - Fax:360-748-8360
Is Sole Proprietor?:No
Enumeration Date:2022-11-04
Last Update Date:2022-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA61352892225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist