Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | OT00003730 | WA |
N | 225XN1300X | Occupational Therapist - Neurorehabilitation | OT00003730 | WA |
NPI | 1275731903 |
---|---|
Provider Name | Serena B Matthews |
First Address | Bainbridge Island, WA 98110-4282 |
Second Address | Bainbridge Island, WA 98110-4282 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/07/2007 |
Last Update Date | 08/12/2015 |