Provider Demographics
NPI:1073715066
Name:MATSON, MICHELLE LIANE (OTR)
Entity type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:LIANE
Last Name:MATSON
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:76 NEW HAMPSHIRE DR
Mailing Address - Street 2:
Mailing Address - City:WEBSTER
Mailing Address - State:NH
Mailing Address - Zip Code:03303-7919
Mailing Address - Country:US
Mailing Address - Phone:603-746-2216
Mailing Address - Fax:
Practice Address - Street 1:239 PLEASANT ST
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NH
Practice Address - Zip Code:03301-7504
Practice Address - Country:US
Practice Address - Phone:603-410-3419
Practice Address - Fax:603-229-4589
Is Sole Proprietor?:No
Enumeration Date:2007-06-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH1691225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist