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General NPI Number Information
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NPI Number | 1487635934
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Entity Type | Individual
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Provider Name | LARRY SCOTT MADDY OTR L CHT
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Gender | Male
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Dates
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Enumeration Date | 11/10/2005
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Last Update Date | 06/16/2014
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Provider Practice Location Address
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Address Line | 257 W KINGS HWY
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City | EDEN
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State | NC
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Zip | 27288-5009
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Country | US
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Telephone | 336-627-4263
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Fax | 336-627-4266
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Provider Business Mailing Address
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Address Line | 8823 PRODUCTION LN
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City | OOLTEWAH
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State | TN
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Zip | 37363-6511
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Country | US
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Telephone | 423-238-7217
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Fax | 423-954-7408
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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 | 1145
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 225XH1200X
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Taxonomy Name | Hand Occupational Therapist
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License Number | 9105000708
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License Number State | NC
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