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Individual

DANIELLE RAE MADDOX

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
MOT, OTR/L

Contact information

Practice address
1107 N LUSK AVE, ELK CITY, OK 73644-2450
Mailing address
1107 N LUSK AVE, ELK CITY, OK 73644-2450
(580) 774-9009

Taxonomy

Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
1168
OK
225XP0200X
Pediatric Occupational Therapist
Primary
5416
OK

Other

Enumeration date
09/12/2011
Last updated
06/17/2020
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