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General NPI Number Information
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NPI Number | 1053067454
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Entity Type | Individual
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Provider Name | MADISON MAE SCHANTZ NUGENT OTR/L
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Gender | Female
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Dates
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Enumeration Date | 02/23/2022
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Last Update Date | 03/12/2025
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Provider Practice Location Address
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Address Line | 120 N RICHARD JACKSON BLVD STE 180
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City | PANAMA CITY BEACH
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State | FL
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Zip | 32407-2522
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Country | US
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Telephone | 850-235-6360
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Fax | 850-235-8871
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Provider Business Mailing Address
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Address Line | 2937 TEN ACRE RD
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City | PANAMA CITY
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State | FL
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Zip | 32405-7129
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Country | US
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Telephone | 567-204-1278
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 20716
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 225XN1300X
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Taxonomy Name | Neurorehabilitation Occupational Therapist
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License Number | 20716
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 225XP0019X
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Taxonomy Name | Physical Rehabilitation Occupational Therapist
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License Number | 20716
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License Number State | FL
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Taxonomy #4
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Taxonomy Code | 225XP0200X
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Taxonomy Name | Pediatric Occupational Therapist
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License Number | 20716
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License Number State | FL
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