Healthcare Provider Details

I. General information

NPI: 1982483244
Provider Name (Legal Business Name): MADYSON PAIGE PICHE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/26/2023
Last Update Date: 09/26/2023
Certification Date: 09/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1800 HERITAGE BLVD
MIDLAND TX
79707-9750
US

IV. Provider business mailing address

3619 E 7 MILE RD
SAULT SAINTE MARIE MI
49783-8636
US

V. Phone/Fax

Practice location:
  • Phone: 432-520-1600
  • Fax:
Mailing address:
  • Phone: 906-440-8180
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0019X
TaxonomyPhysical Rehabilitation Occupational Therapist
License Number124002
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: