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General NPI Number Information
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NPI Number | 1144045097
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Entity Type | Individual
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Provider Name | MADISON ANNE BRODEUR OTD, OTR/L
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Gender | Female
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Dates
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Enumeration Date | 11/16/2024
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Last Update Date | 11/16/2024
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Provider Practice Location Address
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Address Line | 16300 E KEITH MCMAHAN DR
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City | FOUNTAIN HILLS
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State | AZ
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Zip | 85268-0101
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Country | US
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Telephone | 480-836-4800
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Fax |
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Provider Business Mailing Address
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Address Line | 8310 E MCDONALD DR APT 5206
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City | SCOTTSDALE
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State | AZ
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Zip | 85250-6266
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Country | US
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Telephone | 203-815-2819
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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 | OTH-009690
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License Number State | AZ
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