Individual
MADISON FAVETTO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
7500 E INDEPENDENCE BLVD STE 101, CHARLOTTE, NC 28227-9482
(980) 486-8289
(704) 625-0394
Mailing address
7500 E INDEPENDENCE BLVD STE 101, CHARLOTTE, NC 28227-9482
(980) 486-8289
(704) 625-0394
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
121973
TX
225X00000X
Occupational Therapist
Primary
16727
NC
390200000X
Student in an Organized Health Care Education/Training Program
—
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2846675
—
OH
Enumeration date
11/09/2016
Last updated
10/08/2025
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