Provider Demographics
NPI:1093264129
Name:GUIST, MADISON SUE (OTR/L)
Entity Type:Individual
Prefix:
First Name:MADISON
Middle Name:SUE
Last Name:GUIST
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1774 CENTRE ST
Mailing Address - Street 2:SUITE #1
Mailing Address - City:RAPID CITY
Mailing Address - State:SD
Mailing Address - Zip Code:57703-4029
Mailing Address - Country:US
Mailing Address - Phone:605-716-2634
Mailing Address - Fax:605-716-2639
Practice Address - Street 1:1774 CENTRE ST
Practice Address - Street 2:SUITE #1
Practice Address - City:RAPID CITY
Practice Address - State:SD
Practice Address - Zip Code:57703-4029
Practice Address - Country:US
Practice Address - Phone:605-716-2634
Practice Address - Fax:605-716-2639
Is Sole Proprietor?:No
Enumeration Date:2016-09-30
Last Update Date:2016-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD1015225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics