Provider Demographics
NPI:1477252468
Name:MADDEN, SALLY MARIE
Entity Type:Individual
Prefix:
First Name:SALLY
Middle Name:MARIE
Last Name:MADDEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6438 BRANDYWINE DR
Mailing Address - Street 2:
Mailing Address - City:ANDOVER
Mailing Address - State:OH
Mailing Address - Zip Code:44003-9210
Mailing Address - Country:US
Mailing Address - Phone:440-858-5637
Mailing Address - Fax:
Practice Address - Street 1:6438 BRANDYWINE DR
Practice Address - Street 2:
Practice Address - City:ANDOVER
Practice Address - State:OH
Practice Address - Zip Code:44003-9210
Practice Address - Country:US
Practice Address - Phone:440-858-5637
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-28
Last Update Date:2023-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No376J00000XNursing Service Related ProvidersHomemaker