Healthcare Provider Details

I. General information

NPI: 1346616687
Provider Name (Legal Business Name): MADISON MORGAN OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MADISON THIBAULT OTR/L

II. Dates (important events)

Enumeration Date: 08/20/2015
Last Update Date: 12/22/2023
Certification Date: 12/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2021 K ST NW STE 215
WASHINGTON DC
20006-1003
US

IV. Provider business mailing address

2424 MILL RD APT 611
ALEXANDRIA VA
22314-5038
US

V. Phone/Fax

Practice location:
  • Phone: 202-466-9719
  • Fax:
Mailing address:
  • Phone: 484-515-4671
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT210002094
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: