Provider Demographics
NPI:1043964752
Name:O'LOUGHLIN, MADDISON MACY (COTA/L)
Entity Type:Individual
Prefix:
First Name:MADDISON
Middle Name:MACY
Last Name:O'LOUGHLIN
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10200 INDEPENDENCE PKWY APT 409
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75025-8207
Mailing Address - Country:US
Mailing Address - Phone:785-577-6599
Mailing Address - Fax:
Practice Address - Street 1:2851 ORCHID DR
Practice Address - Street 2:
Practice Address - City:MCKINNEY
Practice Address - State:TX
Practice Address - Zip Code:75072-4091
Practice Address - Country:US
Practice Address - Phone:469-343-4999
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-10
Last Update Date:2022-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX216935224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant