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General NPI Number Information
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NPI Number | 1861526162
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Entity Type | Individual
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Provider Name | DAWNNA JEAN MATTESON OTRL
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Gender | Female
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Dates
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Enumeration Date | 03/16/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 6008 W. 159TH ST.
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City | OAK FOREST
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State | IL
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Zip | 60452
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Country | US
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Telephone | 708-535-0933
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Fax |
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Provider Business Mailing Address
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Address Line | 1228 GRAND BLVD
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City | ROMEOVILLE
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State | IL
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Zip | 60446-1761
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Country | US
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Telephone | 815-407-1766
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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 | 225XP0200X
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Taxonomy Name | Pediatric Occupational Therapist
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License Number | 056.007028
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License Number State | IL
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