Provider Demographics
NPI:1194093013
Name:MATSON, KATHRYN LEIGH (COTA)
Entity type:Individual
Prefix:
First Name:KATHRYN
Middle Name:LEIGH
Last Name:MATSON
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:W7900 MEEK RD
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:WI
Mailing Address - Zip Code:53911-9736
Mailing Address - Country:US
Mailing Address - Phone:608-287-6654
Mailing Address - Fax:
Practice Address - Street 1:516 26TH AVE
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:WI
Practice Address - Zip Code:53566-1531
Practice Address - Country:US
Practice Address - Phone:608-325-9141
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-12-06
Last Update Date:2011-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4772-027224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant