MEDICARE: MS. VIVIAN YVONNE MADISON OTR

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225X00000X	Occupational Therapist	0050	AL

General Provider Information

NPI Number	:	1699989368
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. VIVIAN YVONNE MADISON OTR

Provider Business Mailing Address
First Line	:	4863 HUTSON AVE
Second Line	:
City	:	BIRMINGHAM
State	:	AL
Zip	:	35207-1215
Country	:	US
Telephone Number	:	205-669-7455
Fax Number	:	205-328-5821

Provider Business Practice Location Address
First Line	:	4863 HUTSON AVE
Second Line	:
City	:	BIRMINGHAM
State	:	AL
Zip	:	35207-1215
Country	:	US
Telephone Number	:	205-669-7455
Fax Number	:	205-328-5821

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/10/2007
Last Update Date	:	07/08/2007

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