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NPI Code Detail

MEDICARE: MADISON ANNE EOUSE OTR/L

MEDICARE: MADISON ANNE EOUSE OTR/L
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
1225X00000XOccupational TherapistOT19792FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1710442223
Entity Type Code : Individual
Provider Name (Legal Business Name) : MADISON ANNE EOUSE OTR/L
Provider Business Mailing Address
First Line : 9275 POINT CYPRESS DR
Second Line :
City : ORLANDO
State : FL
Zip : 32836-5480
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 4680 LAKE UNDERHILL RD
Second Line :
City : ORLANDO
State : FL
Zip : 32807-1182
Country : US
Telephone Number : 407-381-0907
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/08/2019
Last Update Date : 02/08/2019

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