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General NPI Number Information
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NPI Number | 1356079065
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Entity Type | Individual
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Provider Name | MADELYN BLACK MOT, OTR/L
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Gender | Female
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Dates
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Enumeration Date | 08/10/2022
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Last Update Date | 02/10/2026
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Provider Practice Location Address
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Address Line | 4435 RONALD REAGAN BLVD
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City | JOHNSTOWN
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State | CO
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Zip | 80534-6566
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Country | US
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Telephone | 970-699-7303
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Fax |
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Provider Business Mailing Address
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Address Line | 4435 RONALD REAGAN BLVD
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City | JOHNSTOWN
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State | CO
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Zip | 80534-6566
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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 | OT.0008952
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License Number State | CO
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