Individual
BRYAN D. MATTSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OTR
Contact information
Practice address
1048 W LAWRENCE AVE APT 1, CHICAGO, IL 60640-6544
(773) 968-7871
(773) 561-6882
Mailing address
PO BOX 408799, CHICAGO, IL 60640-8799
(773) 968-7871
(773) 561-6815
Taxonomy
Speciality
Code
Description
License number
State
225XP0200X
Pediatric Occupational Therapist
Primary
—
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01628182
BLUE CROSS PROVIDER #
IL
Enumeration date
06/12/2007
Last updated
02/06/2008
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