Healthcare Provider Details

I. General information

NPI: 1164326757
Provider Name (Legal Business Name): MADISON EMMI OT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/06/2026
Last Update Date: 10/07/2026
Certification Date: 10/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

705 BOSTON POST RD STE 5A
GUILFORD CT
06437-2733
US

IV. Provider business mailing address

705 BOSTON POST RD STE 5A
GUILFORD CT
06437-2733
US

V. Phone/Fax

Practice location:
  • Phone: 203-458-1645
  • Fax: 203-458-1689
Mailing address:
  • Phone: 203-458-1645
  • Fax: 203-458-1689

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number6986
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: