Provider Demographics
NPI:1982905733
Name:MATTHEWS, KIRSTEN R (MA, OTRL, CLT)
Entity type:Individual
Prefix:MRS
First Name:KIRSTEN
Middle Name:R
Last Name:MATTHEWS
Suffix:
Gender:F
Credentials:MA, OTRL, CLT
Other - Prefix:MISS
Other - First Name:KIRSTEN
Other - Middle Name:RAE
Other - Last Name:NELSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA, OTR
Mailing Address - Street 1:901 LAKESHORE DR
Mailing Address - Street 2:
Mailing Address - City:ISHPEMING
Mailing Address - State:MI
Mailing Address - Zip Code:49849-1367
Mailing Address - Country:US
Mailing Address - Phone:906-485-2679
Mailing Address - Fax:906-485-2740
Practice Address - Street 1:97 S 4TH ST
Practice Address - Street 2:SUITE B
Practice Address - City:ISHPEMING
Practice Address - State:MI
Practice Address - Zip Code:49849-2168
Practice Address - Country:US
Practice Address - Phone:906-485-2775
Practice Address - Fax:906-486-1136
Is Sole Proprietor?:No
Enumeration Date:2010-11-10
Last Update Date:2018-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225XP0200X
MI5201006003225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics