Healthcare Provider Details

I. General information

NPI: 1851796619
Provider Name (Legal Business Name): MADISON GARTMAN MS, RD, OTR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/22/2014
Last Update Date: 06/16/2026
Certification Date: 06/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

804 WAREHOUSE ST
JBER AK
99505-8002
US

IV. Provider business mailing address

804 WAREHOUSE ST
JBER AK
99505-8002
US

V. Phone/Fax

Practice location:
  • Phone: 907-384-2730
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number109715
License Number StateAK
# 2
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT-3913
License Number StateMS
# 3
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: