MEDICARE: MADISON PARKER OTR/L

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	225X00000X	Occupational Therapist	5201010690	MI

General Provider Information

NPI Number	:	1750869137
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MADISON PARKER OTR/L

Provider Business Mailing Address
First Line	:	PO BOX 419885
Second Line	:
City	:	BOSTON
State	:	MA
Zip	:	02241-9885
Country	:	US
Telephone Number	:	888-830-4125
Fax Number	:

Provider Business Practice Location Address
First Line	:	1424 S MAIN ST STE 2
Second Line	:
City	:	ADRIAN
State	:	MI
Zip	:	49221-4309
Country	:	US
Telephone Number	:	517-312-1711
Fax Number	:

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

Provider Enumeration Date	:	07/30/2018
Last Update Date	:	09/21/2022

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Directions to “ MADISON PARKER OTR/L” Practice Location

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