Provider Demographics
NPI:1326326174
Name:MADISON, JADE (OTR/L)
Entity Type:Individual
Prefix:
First Name:JADE
Middle Name:
Last Name:MADISON
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:IRINA
Other - Middle Name:
Other - Last Name:SOBYANINA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:OTR/L
Mailing Address - Street 1:5375 PENDINI POINT CT
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89141-0419
Mailing Address - Country:US
Mailing Address - Phone:702-499-0443
Mailing Address - Fax:702-726-9527
Practice Address - Street 1:5375 PENDINI POINT CT
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89141-0419
Practice Address - Country:US
Practice Address - Phone:702-499-0443
Practice Address - Fax:702-726-9527
Is Sole Proprietor?:No
Enumeration Date:2011-07-28
Last Update Date:2011-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV10-0057225X00000X, 225XP0200X, 225XP0019X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No225XP0019XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPhysical Rehabilitation