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General NPI Number Information
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NPI Number | 1558154336
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Entity Type | Individual
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Provider Name | MADISON THOMAS OTRL
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Gender |
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Dates
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Enumeration Date | 05/26/2025
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Last Update Date | 05/26/2025
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Provider Practice Location Address
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Address Line | 21500 HAGGERTY RD STE 160
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City | NORTHVILLE
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State | MI
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Zip | 48167-8992
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Country | US
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Telephone | 855-413-2225
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Fax |
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Provider Business Mailing Address
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Address Line | 2145 HEIDI DR
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City | OXFORD
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State | MI
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Zip | 48370-2812
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Country | US
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Telephone | 248-408-4944
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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 |
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License Number State |
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