Provider Demographics
NPI:1114640182
Name:MADDOX, JARROD (OTD, OTR, CHT)
Entity Type:Individual
Prefix:
First Name:JARROD
Middle Name:
Last Name:MADDOX
Suffix:
Gender:M
Credentials:OTD, OTR, CHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:140 HILLCREST MEDICAL BLVD BLDG III 1
Mailing Address - Street 2:
Mailing Address - City:WACO
Mailing Address - State:TX
Mailing Address - Zip Code:76712-8897
Mailing Address - Country:US
Mailing Address - Phone:254-202-7180
Mailing Address - Fax:254-202-7184
Practice Address - Street 1:140 HILLCREST MEDICAL BLVD BLDG III 1
Practice Address - Street 2:
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76712-8897
Practice Address - Country:US
Practice Address - Phone:254-202-7180
Practice Address - Fax:254-202-7184
Is Sole Proprietor?:No
Enumeration Date:2022-09-23
Last Update Date:2022-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX114007225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand