Provider Demographics
NPI:1760172639
Name:WIRTH, MADISYN (OTRL)
Entity Type:Individual
Prefix:
First Name:MADISYN
Middle Name:
Last Name:WIRTH
Suffix:
Gender:F
Credentials:OTRL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1289 S LINDEN RD STE A
Mailing Address - Street 2:
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48532-3499
Mailing Address - Country:US
Mailing Address - Phone:810-230-9750
Mailing Address - Fax:810-230-8799
Practice Address - Street 1:1289 S LINDEN RD STE A
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48532-3499
Practice Address - Country:US
Practice Address - Phone:810-230-9750
Practice Address - Fax:810-230-8799
Is Sole Proprietor?:No
Enumeration Date:2023-05-12
Last Update Date:2023-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist