MEDICARE: MRS. KATHRYN MATALA MATSUBUCHI OT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225X00000X	Occupational Therapist	OT00002727	WA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0351054	OTHER	WA	DEPT OF L&I
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1093925943
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. KATHRYN MATALA MATSUBUCHI OT

Provider Business Mailing Address
First Line	:	3010 S SOUTHEAST BLVD STE G
Second Line	:
City	:	SPOKANE
State	:	WA
Zip	:	99223-3542
Country	:	US
Telephone Number	:	509-532-0500
Fax Number	:	509-532-8810

Provider Business Practice Location Address
First Line	:	3010 S SOUTHEAST BLVD STE G
Second Line	:
City	:	SPOKANE
State	:	WA
Zip	:	99223-3542
Country	:	US
Telephone Number	:	509-532-0500
Fax Number	:	509-532-8810

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/22/2007
Last Update Date	:	04/22/2021

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