Provider Demographics
NPI:1689342867
Name:HUFFMAN, MADISON CLAIRE (OTD)
Entity Type:Individual
Prefix:
First Name:MADISON
Middle Name:CLAIRE
Last Name:HUFFMAN
Suffix:
Gender:F
Credentials:OTD
Other - Prefix:
Other - First Name:MADISON
Other - Middle Name:CLAIRE
Other - Last Name:MCALEAVEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTD
Mailing Address - Street 1:1815 NW 169TH PL #3070
Mailing Address - Street 2:
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97006
Mailing Address - Country:US
Mailing Address - Phone:971-249-2653
Mailing Address - Fax:
Practice Address - Street 1:BOLD PEDIATRIC THERAPY CENTER
Practice Address - Street 2:1815 NW 169TH PL #3070
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97006
Practice Address - Country:US
Practice Address - Phone:971-249-2653
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-01
Last Update Date:2022-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LP2794225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics