Healthcare Provider Details

I. General information

NPI: 1013828920
Provider Name (Legal Business Name): MICHELE EVE MADRU OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/17/2026
Last Update Date: 09/17/2026
Certification Date: 09/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10790 OLD SAINT AUGUSTINE RD
JACKSONVILLE FL
32257-1078
US

IV. Provider business mailing address

1061 MAD FOX DR
JACKSONVILLE FL
32212-1124
US

V. Phone/Fax

Practice location:
  • Phone: 904-260-0800
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number0T25412
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: