Provider Demographics
NPI:1376120519
Name:SMITH, MADELINE ROSE (OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:MADELINE
Middle Name:ROSE
Last Name:SMITH
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:MISS
Other - First Name:MADELINE
Other - Middle Name:ROSE
Other - Last Name:ROSSO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:14 E MONMOUTH ST
Mailing Address - Street 2:
Mailing Address - City:WINCHESTER
Mailing Address - State:VA
Mailing Address - Zip Code:22601-4648
Mailing Address - Country:US
Mailing Address - Phone:540-686-0181
Mailing Address - Fax:
Practice Address - Street 1:14 E MONMOUTH ST
Practice Address - Street 2:
Practice Address - City:WINCHESTER
Practice Address - State:VA
Practice Address - Zip Code:22601-4648
Practice Address - Country:US
Practice Address - Phone:540-686-0181
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-25
Last Update Date:2021-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0119008965225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist