Provider Demographics
NPI:1326409269
Name:PARIS, MADIA (MS, OTR/L)
Entity Type:Individual
Prefix:MS
First Name:MADIA
Middle Name:
Last Name:PARIS
Suffix:
Gender:F
Credentials:MS, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:217 STATION ST
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28546-6304
Mailing Address - Country:US
Mailing Address - Phone:910-378-2501
Mailing Address - Fax:910-939-1490
Practice Address - Street 1:217 STATION ST
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28546-6304
Practice Address - Country:US
Practice Address - Phone:910-378-2501
Practice Address - Fax:910-939-1490
Is Sole Proprietor?:No
Enumeration Date:2016-03-18
Last Update Date:2022-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9683225X00000X, 225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist