Healthcare Provider Details

I. General information

NPI: 1093454019
Provider Name (Legal Business Name): MADISEN MCCARTHY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/27/2022
Last Update Date: 08/04/2026
Certification Date: 08/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17100 E SHEA BLVD STE 600
FOUNTAIN HILLS AZ
85268-6663
US

IV. Provider business mailing address

9190 N 83RD AVE UNIT 1169
PEORIA AZ
85345-8062
US

V. Phone/Fax

Practice location:
  • Phone: 708-321-0855
  • Fax:
Mailing address:
  • Phone: 815-475-0200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOTH-010008
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: