Provider Demographics
NPI:1801009097
Name:MADALON, DANA MARIE (OTR)
Entity Type:Individual
Prefix:MRS
First Name:DANA
Middle Name:MARIE
Last Name:MADALON
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:DANA
Other - Middle Name:
Other - Last Name:JONES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR
Mailing Address - Street 1:4111 ORMOND RD
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40207-2166
Mailing Address - Country:US
Mailing Address - Phone:502-893-9448
Mailing Address - Fax:502-515-6888
Practice Address - Street 1:4111 ORMOND RD
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40207-2166
Practice Address - Country:US
Practice Address - Phone:502-893-9448
Practice Address - Fax:502-515-6888
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYKY-R0934225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY1777OtherFIRST STEPS PROVIDER #