Healthcare Provider Details

I. General information

NPI: 1164812434
Provider Name (Legal Business Name): MADISON HUGHES OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/26/2015
Last Update Date: 10/30/2024
Certification Date: 10/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3720 CHURCH ROCK ST
GALLUP NM
87301-4572
US

IV. Provider business mailing address

105 MULBERRY ST
COTTONWOOD FALLS KS
66845-9757
US

V. Phone/Fax

Practice location:
  • Phone: 316-214-4542
  • Fax:
Mailing address:
  • Phone: 316-214-4542
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License NumberT-04097
License Number StateKS
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT02273
License Number StateRI
# 3
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT-2024-0183
License Number StateNM
# 4
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT009044
License Number StateGA
# 5
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number17-03512
License Number StateKS
# 6
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: