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General NPI Number Information
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NPI Number | 1184111205
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Entity Type | Individual
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Provider Name | MATTHEW STUTZENBERGER OT
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Gender | Male
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Dates
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Enumeration Date | 04/13/2018
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Last Update Date | 04/13/2018
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Provider Practice Location Address
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Address Line | 1660 S COLUMBIAN WAY
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City | SEATTLE
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State | WA
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Zip | 98108-1532
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Country | US
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Telephone | 206-762-1010
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Fax |
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Provider Business Mailing Address
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Address Line | 1213 N 49TH ST
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City | SEATTLE
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State | WA
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Zip | 98103-6632
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Country | US
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Telephone | 206-604-7285
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | OT60827749
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License Number State | WA
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