Provider Demographics
NPI:1659035939
Name:VOLPERT, MADISON (OTD)
Entity Type:Individual
Prefix:
First Name:MADISON
Middle Name:
Last Name:VOLPERT
Suffix:
Gender:F
Credentials:OTD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1523 E WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:CHATHAM
Mailing Address - State:IL
Mailing Address - Zip Code:62629-1541
Mailing Address - Country:US
Mailing Address - Phone:217-317-3193
Mailing Address - Fax:
Practice Address - Street 1:3131 GREENHEAD DR STE D
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:IL
Practice Address - Zip Code:62711-7426
Practice Address - Country:US
Practice Address - Phone:217-891-1524
Practice Address - Fax:855-246-2163
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-24
Last Update Date:2021-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL056014231225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL056014231OtherDEPARTMENT OF FINANCIAL AND PROFESSIONAL REGULATION