Provider Demographics
NPI:1659025567
Name:SALES, MADISON
Entity Type:Individual
Prefix:
First Name:MADISON
Middle Name:
Last Name:SALES
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 1:19731 GRAVE RUN RD
Mailing Address - Street 2:
Mailing Address - City:HAMPSTEAD
Mailing Address - State:MD
Mailing Address - Zip Code:21074-2729
Mailing Address - Country:US
Mailing Address - Phone:443-823-8393
Mailing Address - Fax:
Practice Address - Street 1:2319 HANOVER PIKE
Practice Address - Street 2:
Practice Address - City:HAMPSTEAD
Practice Address - State:MD
Practice Address - Zip Code:21074-1137
Practice Address - Country:US
Practice Address - Phone:410-374-0925
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-09
Last Update Date:2022-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD09554225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist