Provider Demographics
NPI:1578187142
Name:SCUDERI, MADELEINE DOROTHY (OTR)
Entity Type:Individual
Prefix:
First Name:MADELEINE
Middle Name:DOROTHY
Last Name:SCUDERI
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 1:88 FERRELL RD
Mailing Address - Street 2:
Mailing Address - City:MULLICA HILL
Mailing Address - State:NJ
Mailing Address - Zip Code:08062-4512
Mailing Address - Country:US
Mailing Address - Phone:856-472-2858
Mailing Address - Fax:
Practice Address - Street 1:32 SWEDES BRIDGE RD
Practice Address - Street 2:
Practice Address - City:MANNINGTON
Practice Address - State:NJ
Practice Address - Zip Code:08079-4019
Practice Address - Country:US
Practice Address - Phone:856-472-2858
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-29
Last Update Date:2020-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ46TR00930200225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist