Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225X00000X | Occupational Therapist | 10-0057 | NV |
N | 225XP0019X | Occupational Therapist - Physical Rehabilitation | 10-0057 | NV |
Y | 225XP0200X | Occupational Therapist - Pediatrics | 10-0057 | NV |
NPI | 1326326174 |
---|---|
Provider Name | Jade Madison |
First Address | Las Vegas, NV 89141-0419 |
Second Address | Las Vegas, NV 89141-0419 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/07/2011 |
Last Update Date | 11/08/2011 |