Provider Demographics
NPI:1629847868
Name:LEDERER, MADELEINE (OTR/L)
Entity Type:Individual
Prefix:
First Name:MADELEINE
Middle Name:
Last Name:LEDERER
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:MADELEINE
Other - Middle Name:
Other - Last Name:PRIEBE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4741 LARKSPUR CIR
Mailing Address - Street 2:
Mailing Address - City:LAWRENCE
Mailing Address - State:KS
Mailing Address - Zip Code:66047-3354
Mailing Address - Country:US
Mailing Address - Phone:920-358-4424
Mailing Address - Fax:
Practice Address - Street 1:2999 OLYMPUS BLVD
Practice Address - Street 2:
Practice Address - City:COPPELL
Practice Address - State:TX
Practice Address - Zip Code:75019-0122
Practice Address - Country:US
Practice Address - Phone:469-524-1506
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-28
Last Update Date:2023-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR4223785225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist