Healthcare Provider Details

I. General information

NPI: 1174454045
Provider Name (Legal Business Name): MADISON ALEXIS ARETZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/28/2026
Last Update Date: 05/28/2026
Certification Date: 05/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

213 LAURENS ST NW
AIKEN SC
29801-3911
US

IV. Provider business mailing address

121 PADDOCKS BND
AIKEN SC
29803-6998
US

V. Phone/Fax

Practice location:
  • Phone: 803-643-4200
  • Fax:
Mailing address:
  • Phone: 936-333-2824
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number551594
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: