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Individual

LARRY SCOTT MADDY

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
OTR L CHT

Contact information

Practice address
257 W KINGS HWY, EDEN, NC 27288-5009
(336) 627-4263
(336) 627-4266
Mailing address
8823 PRODUCTION LN, OOLTEWAH, TN 37363-6511
(423) 238-7217
(423) 954-7408

Taxonomy

Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
1145
NC
225XH1200X
Hand Occupational Therapist
9105000708
NC

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
2510062C
MEDICARE OCCUPATIONAL THERAPY
NC
01
53709
BCBS
NC
01
66985
MEDCOST
01
670000776
MEDICARE RAILROAD
NC
05
7301040
NC
Enumeration date
11/10/2005
Last updated
06/16/2014
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