Provider Demographics
NPI:1891258042
Name:CONNETTE, MADISON FROESCH (OTR/L)
Entity Type:Individual
Prefix:
First Name:MADISON
Middle Name:FROESCH
Last Name:CONNETTE
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:MADISON
Other - Middle Name:
Other - Last Name:FROESCH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR/L
Mailing Address - Street 1:3631 OAK CREEK DR UNIT C
Mailing Address - Street 2:
Mailing Address - City:ONTARIO
Mailing Address - State:CA
Mailing Address - Zip Code:91761-0728
Mailing Address - Country:US
Mailing Address - Phone:714-315-6315
Mailing Address - Fax:
Practice Address - Street 1:2641 HAMNER AVE STE 110
Practice Address - Street 2:
Practice Address - City:NORCO
Practice Address - State:CA
Practice Address - Zip Code:92860-3637
Practice Address - Country:US
Practice Address - Phone:626-536-4834
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-12
Last Update Date:2023-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106S00000X
CA24215225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician