Healthcare Provider Details

I. General information

NPI: 1255296943
Provider Name (Legal Business Name): MADISON BROOKE OSBERN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/16/2025
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3419 50TH ST
DES MOINES IA
50310-2647
US

IV. Provider business mailing address

3419 50TH ST
DES MOINES IA
50310-2647
US

V. Phone/Fax

Practice location:
  • Phone: 913-633-6747
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number135841
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: