Provider Demographics
NPI:1083215727
Name:FOSKEY, MADISON BROOKE (COTA/L)
Entity Type:Individual
Prefix:
First Name:MADISON
Middle Name:BROOKE
Last Name:FOSKEY
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 1:3700 LEGACY DR APT 22105
Mailing Address - Street 2:
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75034-6650
Mailing Address - Country:US
Mailing Address - Phone:214-783-0638
Mailing Address - Fax:
Practice Address - Street 1:3700 LEGACY DR APT 22105
Practice Address - Street 2:
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75034-6650
Practice Address - Country:US
Practice Address - Phone:214-783-0638
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-07
Last Update Date:2020-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX216557224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX216557OtherLICENSE #