Healthcare Provider Details

I. General information

NPI: 1174485718
Provider Name (Legal Business Name): MADISON CLAIRE ALFANO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/02/2025
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1289 OLIVER ST
FAYETTEVILLE NC
28304-4450
US

IV. Provider business mailing address

PO BOX 87294
FAYETTEVILLE NC
28304-7294
US

V. Phone/Fax

Practice location:
  • Phone: 910-483-8331
  • Fax: 910-483-8335
Mailing address:
  • Phone: 910-483-8331
  • Fax: 910-483-8335

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number18161
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT009566
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: