Provider Demographics
NPI:1104077510
Name:MATTSON, MEGHAN ELIZABETH (ATC)
Entity type:Individual
Prefix:MS
First Name:MEGHAN
Middle Name:ELIZABETH
Last Name:MATTSON
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:605 ASHLAND AVE
Mailing Address - Street 2:
Mailing Address - City:MAYS LANDING
Mailing Address - State:NJ
Mailing Address - Zip Code:08330-1663
Mailing Address - Country:US
Mailing Address - Phone:609-457-3880
Mailing Address - Fax:
Practice Address - Street 1:605 ASHLAND AVE
Practice Address - Street 2:
Practice Address - City:MAYS LANDING
Practice Address - State:NJ
Practice Address - Zip Code:08330-1663
Practice Address - Country:US
Practice Address - Phone:609-457-3880
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-03
Last Update Date:2008-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MT001479002255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer