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General NPI Number Information
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NPI Number | 1639519358
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Entity Type | Individual
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Provider Name | MATTHEW WALLACE MITCHELL OTR/L
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Gender | Male
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Dates
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Enumeration Date | 06/26/2013
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Last Update Date | 06/26/2013
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Provider Practice Location Address
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Address Line | 91 W VALLEY RD
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City | CHIMACUM
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State | WA
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Zip | 98325-7731
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Country | US
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Telephone | 360-732-4090
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Fax |
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Provider Business Mailing Address
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Address Line | 1044 WATER ST SUITE 339
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City | PORT TOWNSEND
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State | WA
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Zip | 98368-6706
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Country | US
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Telephone | 360-441-0142
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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 | OT00004327
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License Number State | WA
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