Healthcare Provider Details

I. General information

NPI: 1982905733
Provider Name (Legal Business Name): KIRSTEN R MATTHEWS MA, OTRL, CLT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KIRSTEN RAE NELSON MA, OTR

II. Dates (important events)

Enumeration Date: 11/10/2010
Last Update Date: 02/22/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

97 S 4TH ST SUITE B
ISHPEMING MI
49849-2168
US

IV. Provider business mailing address

901 LAKESHORE DR
ISHPEMING MI
49849-1367
US

V. Phone/Fax

Practice location:
  • Phone: 906-485-2775
  • Fax: 906-486-1136
Mailing address:
  • Phone: 906-485-2679
  • Fax: 906-485-2740

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number5201006003
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: