Provider Demographics
NPI:1356819585
Name:MITCHELL, MADISON NICOLE (OT R/L)
Entity Type:Individual
Prefix:MS
First Name:MADISON
Middle Name:NICOLE
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:OT R/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2000 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:PARIS
Mailing Address - State:KY
Mailing Address - Zip Code:40361-1149
Mailing Address - Country:US
Mailing Address - Phone:859-987-5750
Mailing Address - Fax:
Practice Address - Street 1:2000 MAIN ST
Practice Address - Street 2:
Practice Address - City:PARIS
Practice Address - State:KY
Practice Address - Zip Code:40361-1149
Practice Address - Country:US
Practice Address - Phone:859-987-5750
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-06
Last Update Date:2018-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY245122225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist