Provider Demographics
NPI:1942018049
Name:MATISON, STEPHANIE PAULE
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:PAULE
Last Name:MATISON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10215 SHARON ST SW
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98498-3844
Mailing Address - Country:US
Mailing Address - Phone:253-304-0771
Mailing Address - Fax:
Practice Address - Street 1:10215 SHARON ST SW
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:WA
Practice Address - Zip Code:98498-3844
Practice Address - Country:US
Practice Address - Phone:253-304-0771
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-20
Last Update Date:2024-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist