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General NPI Number Information
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NPI Number | 1578688081
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Entity Type | Individual
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Provider Name | KIMBERLY ANN MATSKO PTA
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Gender | Female
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Dates
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Enumeration Date | 03/21/2007
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Last Update Date | 09/13/2012
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Provider Practice Location Address
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Address Line | 813 SILVER SAGE TRL
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City | MIDDLETON
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State | WI
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Zip | 53562-5684
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Country | US
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Telephone | 608-469-3794
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Fax |
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Provider Business Mailing Address
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Address Line | 813 SILVER SAGE TRAIL
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City | MIDDLETON
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State | WI
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Zip | 53562
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Country | US
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Telephone | 608-469-3794
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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 | 174400000X
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Taxonomy Name | Specialist
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License Number | 1902-19
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License Number State | WI
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Taxonomy #2
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 160.005474
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License Number State | IL
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