MEDICARE: MARLO YVETTE MADOX

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	385HR2060X	Child Intellectual and/or Developmental Disabilities Respite Care

General Provider Information

NPI Number	:	1164019816
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARLO YVETTE MADOX

Provider Business Mailing Address
First Line	:	24900 PICONE LN
Second Line	:
City	:	BEDFORD HTS
State	:	OH
Zip	:	44146-1953
Country	:	US
Telephone Number	:	216-421-4363
Fax Number	:

Provider Business Practice Location Address
First Line	:	24900 PICONE LN
Second Line	:
City	:	BEDFORD HTS
State	:	OH
Zip	:	44146-1953
Country	:	US
Telephone Number	:	216-421-4363
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/29/2020
Last Update Date	:	05/06/2026

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