Provider Demographics
NPI:1902415649
Name:MCQUISTON, MADISON WYN (OT)
Entity Type:Individual
Prefix:
First Name:MADISON
Middle Name:WYN
Last Name:MCQUISTON
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:983A E LANCASTER AVE
Mailing Address - Street 2:
Mailing Address - City:DOWNINGTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19335-3328
Mailing Address - Country:US
Mailing Address - Phone:610-594-2060
Mailing Address - Fax:
Practice Address - Street 1:245 E CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:COATESVILLE
Practice Address - State:PA
Practice Address - Zip Code:19320-3232
Practice Address - Country:US
Practice Address - Phone:610-466-7060
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-29
Last Update Date:2020-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOC017085225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist