Provider Demographics
NPI:1548775398
Name:SCHENK, MADALYN JO (OTR)
Entity Type:Individual
Prefix:
First Name:MADALYN
Middle Name:JO
Last Name:SCHENK
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:811 E BASELINE RD
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47725-9340
Mailing Address - Country:US
Mailing Address - Phone:812-868-7269
Mailing Address - Fax:
Practice Address - Street 1:811 E BASELINE RD
Practice Address - Street 2:
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47725-9340
Practice Address - Country:US
Practice Address - Phone:812-868-7269
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-12-01
Last Update Date:2020-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN31006511A225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist