Individual
MADISON NICOLE MALCOLM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
COTA/L
Contact information
Practice address
120 N PERKINS RD STE F, STILLWATER, OK 74075-5524
(405) 564-2701
Mailing address
120 N PERKINS RD STE F, STILLWATER, OK 74075-5524
(405) 564-2701
(888) 581-6850
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
2281
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2281
COTA/L
OK
Enumeration date
02/09/2021
Last updated
11/30/2022
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