Healthcare Provider Details

I. General information

NPI: 1235968652
Provider Name (Legal Business Name): KRISTIN E MATHER OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: KRISSY MATHER OTR/L

II. Dates (important events)

Enumeration Date: 08/01/2024
Last Update Date: 04/27/2026
Certification Date: 04/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2175 PROCTOR VALLEY RD
CHULA VISTA CA
91914-4026
US

IV. Provider business mailing address

3752 33RD ST APT 7
SAN DIEGO CA
92104-3792
US

V. Phone/Fax

Practice location:
  • Phone: 619-397-5225
  • Fax:
Mailing address:
  • Phone: 949-306-6479
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number26791
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number26791
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: