=====================================================
General NPI Number Information
=====================================================
NPI Number | 1912880915
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MADISON MITCHELL OTD, OTR/L
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/28/2025
-----------------------------------------------------
Last Update Date | 07/28/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 16000 DILLARD DR STE 2B
-----------------------------------------------------
City | JERSEY VILLAGE
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77040-2085
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 281-410-1980
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 525 W 24TH ST APT 1153
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77008-2188
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 337-852-3002
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225XP0200X
-----------------------------------------------------
Taxonomy Name | Pediatric Occupational Therapist
-----------------------------------------------------
License Number | 125735
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------