Provider Demographics
NPI:1457510679
Name:MAEDGEN, JORDAN (OTR/L)
Entity Type:Individual
Prefix:MS
First Name:JORDAN
Middle Name:
Last Name:MAEDGEN
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12605 EAST FWY
Mailing Address - Street 2:SUITE 212
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77015-5625
Mailing Address - Country:US
Mailing Address - Phone:713-453-0400
Mailing Address - Fax:
Practice Address - Street 1:12605 EAST FWY
Practice Address - Street 2:SUITE 212
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77015-5625
Practice Address - Country:US
Practice Address - Phone:713-453-0400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-03
Last Update Date:2008-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX112522225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist