Individual
BLAIR ELLYSE MADKINS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
COTA/L, BS, AAS
Contact information
Practice address
14248 CHAPS DR, DALLAS, TX 75253-5305
(936) 371-3094
Mailing address
14248 CHAPS DR, DALLAS, TX 75253-5305
(936) 371-3094
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
216479
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
216479
TEXAS BOARD OF OCCUPATIONAL THERAPY EXAMINERS
TX
Enumeration date
09/25/2020
Last updated
09/25/2020
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