Provider Demographics
NPI:1568209245
Name:MATTSON, MOLLY CATHERINE (ATC)
Entity type:Individual
Prefix:
First Name:MOLLY
Middle Name:CATHERINE
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 1:152 SINCLAIR LN
Mailing Address - Street 2:
Mailing Address - City:SELAH
Mailing Address - State:WA
Mailing Address - Zip Code:98942-9745
Mailing Address - Country:US
Mailing Address - Phone:509-834-0364
Mailing Address - Fax:
Practice Address - Street 1:502 E BOONE AVE
Practice Address - Street 2:AD BOX 66
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99258-0066
Practice Address - Country:US
Practice Address - Phone:509-313-4202
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-10
Last Update Date:2024-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer