Healthcare Provider Details

I. General information

NPI: 1558179879
Provider Name (Legal Business Name): MADYSEN COX
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/19/2024
Last Update Date: 09/24/2026
Certification Date: 09/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 W TAYLOR ST
KOKOMO IN
46901-4554
US

IV. Provider business mailing address

617 TOMAHAWK BLVD
KOKOMO IN
46902-5554
US

V. Phone/Fax

Practice location:
  • Phone: 765-419-0411
  • Fax:
Mailing address:
  • Phone: 765-437-4406
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-24-329079
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: