=====================================================
General NPI Number Information
=====================================================
NPI Number | 1528844867
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MADISON TESI OTD, OTR/L
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/04/2023
-----------------------------------------------------
Last Update Date | 09/04/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 611 WINDMILLER DR
-----------------------------------------------------
City | PICKERINGTON
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 43147-9867
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 614-834-1016
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5756 RIVERTON RD
-----------------------------------------------------
City | COLUMBUS
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 43232-1649
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 614-580-8326
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225X00000X
-----------------------------------------------------
Taxonomy Name | Occupational Therapist
-----------------------------------------------------
License Number | 012515
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------