Provider Demographics
NPI:1316404536
Name:MADDOX REHAB LLC
Entity Type:Organization
Organization Name:MADDOX REHAB LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KOURTNEY
Authorized Official - Middle Name:
Authorized Official - Last Name:MADDOX
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:317-945-2557
Mailing Address - Street 1:8338 W CHEROKEE LN
Mailing Address - Street 2:
Mailing Address - City:FAIRLAND
Mailing Address - State:IN
Mailing Address - Zip Code:46126-9684
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8338 W CHEROKEE LN
Practice Address - Street 2:
Practice Address - City:FAIRLAND
Practice Address - State:IN
Practice Address - Zip Code:46126-9684
Practice Address - Country:US
Practice Address - Phone:317-945-2557
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-24
Last Update Date:2019-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty