Provider Demographics
NPI:1700059797
Name:MATHIEU, PASCALE
Entity Type:Individual
Prefix:MS
First Name:PASCALE
Middle Name:
Last Name:MATHIEU
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:PASCALE
Other - Middle Name:
Other - Last Name:MATHEIU
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OT
Mailing Address - Street 1:15 SAINT CLAIRE LN NE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30324-2960
Mailing Address - Country:US
Mailing Address - Phone:404-384-2384
Mailing Address - Fax:
Practice Address - Street 1:15 SAINT CLAIRE LN NE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30324-2960
Practice Address - Country:US
Practice Address - Phone:404-384-2384
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-10
Last Update Date:2008-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOT003578225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist