Individual
MARY GRACE MADISON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
OTR
Contact information
Practice address
4131 SE GRANT ST, PORTLAND, OR 97214-5936
(816) 896-9386
Mailing address
4131 SE GRANT ST, PORTLAND, OR 97214-5936
(816) 896-9386
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
1001320
OR
225X00000X
Occupational Therapist
2005040669
MO
Other
Enumeration date
04/07/2017
Last updated
11/05/2024
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