Healthcare Provider Details

I. General information

NPI: 1487635934
Provider Name (Legal Business Name): LARRY SCOTT MADDY OTR L CHT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/10/2005
Last Update Date: 06/16/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

257 W KINGS HWY
EDEN NC
27288-5009
US

IV. Provider business mailing address

8823 PRODUCTION LN
OOLTEWAH TN
37363-6511
US

V. Phone/Fax

Practice location:
  • Phone: 336-627-4263
  • Fax: 336-627-4266
Mailing address:
  • Phone: 423-238-7217
  • Fax: 423-954-7408

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number1145
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code225XH1200X
TaxonomyHand Occupational Therapist
License Number9105000708
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: