Individual
MADISON WEST
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
OTR/L
Contact information
Practice address
320 MARKET ST., NEWPORT, NC 28570
(252) 648-7543
Mailing address
401 GAVINS RUN, SNEADS FERRY, NC 28460-2302
(228) 297-3526
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
15677
NC
225X00000X
Occupational Therapist
5285
AL
Other
Enumeration date
10/15/2020
Last updated
04/27/2023
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