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General NPI Number Information
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NPI Number | 1083387583
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Entity Type | Individual
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Provider Name | MADISON HARLESS OTD
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Gender | Female
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Dates
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Enumeration Date | 07/29/2021
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Last Update Date | 07/29/2021
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Provider Practice Location Address
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Address Line | 1971 STATE ST
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City | COLUMBUS
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State | IN
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Zip | 47201-7167
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Country | US
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Telephone | 864-244-3626
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Fax |
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Provider Business Mailing Address
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Address Line | 616 EMMA DR
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City | SEYMOUR
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State | IN
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Zip | 47274-4157
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Country | US
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Telephone |
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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 | 31007172A
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License Number State | IN
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