Provider Demographics
NPI:1780691824
Name:MATTHEWS BROWNELL, MARY M (OT)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:M
Last Name:MATTHEWS BROWNELL
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2806 MARTIN ST
Mailing Address - Street 2:
Mailing Address - City:DUPONT
Mailing Address - State:WA
Mailing Address - Zip Code:98327-8743
Mailing Address - Country:US
Mailing Address - Phone:253-686-1682
Mailing Address - Fax:
Practice Address - Street 1:1804 W UNION AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98405-2062
Practice Address - Country:US
Practice Address - Phone:253-759-4036
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-02
Last Update Date:2011-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOT00002488225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist