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General NPI Number Information
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NPI Number | 1376154823
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Entity Type | Individual
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Provider Name | MADDISON MARIAH ROUSE OTR/L
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Gender | Female
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Dates
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Enumeration Date | 08/10/2020
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Last Update Date | 08/10/2020
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Provider Practice Location Address
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Address Line | 3575 N MOORPARK RD
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City | THOUSAND OAKS
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State | CA
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Zip | 91360-2666
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Country | US
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Telephone | 206-719-6349
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Fax |
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Provider Business Mailing Address
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Address Line | 5950 GABBERT RD
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City | MOORPARK
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State | CA
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Zip | 93021-1010
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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 | 60905100
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License Number State | WA
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Taxonomy #2
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 20775
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License Number State | CA
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