| NPI | 1538784277 |
|---|---|
| Former Name | MATTISON MARY NICOLE WEBER |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: OK 883) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: OK 2836) |
| Enumeration Date | 2020-06-09 |
| Last Update Date | 2022-04-18 |