Provider Demographics
NPI:1679246300
Name:COMPTON, MADISON SAREN (OTR/L)
Entity Type:Individual
Prefix:
First Name:MADISON
Middle Name:SAREN
Last Name:COMPTON
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:MADISON
Other - Middle Name:MARILYN
Other - Last Name:SAREN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:645 KENSINGTON FARMS DR
Mailing Address - Street 2:
Mailing Address - City:MILTON
Mailing Address - State:GA
Mailing Address - Zip Code:30004-3768
Mailing Address - Country:US
Mailing Address - Phone:678-977-7440
Mailing Address - Fax:
Practice Address - Street 1:1860 ATKINSON RD STE 101
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30043-5066
Practice Address - Country:US
Practice Address - Phone:706-948-2773
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-28
Last Update Date:2022-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOT008117225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist