Provider Demographics
NPI:1417030925
Name:MADRILL, ROBERT CHAD (OTR)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:CHAD
Last Name:MADRILL
Suffix:
Gender:M
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29 VERDOSA DR
Mailing Address - Street 2:
Mailing Address - City:PUEBLO
Mailing Address - State:CO
Mailing Address - Zip Code:81005-2941
Mailing Address - Country:US
Mailing Address - Phone:719-546-0532
Mailing Address - Fax:
Practice Address - Street 1:29 VERDOSA DR
Practice Address - Street 2:
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81005-2941
Practice Address - Country:US
Practice Address - Phone:719-546-0532
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO989930225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist