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General NPI Number Information
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NPI Number | 1316831985
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Entity Type | Individual
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Provider Name | MADISON MACKENZIE RYAN
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Gender | Female
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Dates
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Enumeration Date | 06/06/2025
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Last Update Date | 06/06/2025
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Provider Practice Location Address
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Address Line | 212 STATE ROAD 436
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City | CASSELBERRY
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State | FL
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Zip | 32707-4943
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Country | US
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Telephone | 689-255-1075
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Fax | 689-255-1075
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Provider Business Mailing Address
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Address Line | 4075 N LAKE ORLANDO PKWY APT 2218
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City | ORLANDO
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State | FL
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Zip | 32808-0974
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Country | US
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Telephone | 585-236-9230
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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 | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number |
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License Number State |
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