Provider Demographics
NPI:1487635934
Name:MADDY, LARRY SCOTT (OTR L CHT)
Entity Type:Individual
Prefix:
First Name:LARRY
Middle Name:SCOTT
Last Name:MADDY
Suffix:
Gender:M
Credentials:OTR L CHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8823 PRODUCTION LN
Mailing Address - Street 2:
Mailing Address - City:OOLTEWAH
Mailing Address - State:TN
Mailing Address - Zip Code:37363-6511
Mailing Address - Country:US
Mailing Address - Phone:423-238-7217
Mailing Address - Fax:423-954-7408
Practice Address - Street 1:257 W KINGS HWY
Practice Address - Street 2:
Practice Address - City:EDEN
Practice Address - State:NC
Practice Address - Zip Code:27288-5009
Practice Address - Country:US
Practice Address - Phone:336-627-4263
Practice Address - Fax:336-627-4266
Is Sole Proprietor?:No
Enumeration Date:2005-11-10
Last Update Date:2014-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1145225X00000X
NC9105000708225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand
Provider Identifiers
StateIdentifier IDID TypeIssuer
66985OtherMEDCOST
NC7301040Medicaid
NC2510062COtherMEDICARE OCCUPATIONAL THERAPY
NC53709OtherBCBS
NC670000776OtherMEDICARE RAILROAD