Healthcare Provider Details

I. General information

NPI: 1427542703
Provider Name (Legal Business Name): MADISON SUZANNE ANDERSON OT, MOT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MADISON SUZANNE ZUBRADT OT, MOT

II. Dates (important events)

Enumeration Date: 06/19/2018
Last Update Date: 10/08/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10801 E STATE ROUTE 350 STE B
RAYTOWN MO
64138
US

IV. Provider business mailing address

6397 LEE HWY STE 300
CHATTANOOGA TN
37421-2564
US

V. Phone/Fax

Practice location:
  • Phone: 816-737-5500
  • Fax: 816-737-5504
Mailing address:
  • Phone: 423-238-7217
  • Fax: 423-238-3473

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number17-03456
License Number StateKS
# 2
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number2018028563
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: