Provider Demographics
NPI:1912538083
Name:CORNELIA, MADISON JANE (OT)
Entity Type:Individual
Prefix:
First Name:MADISON
Middle Name:JANE
Last Name:CORNELIA
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:MADISON
Other - Middle Name:JANE
Other - Last Name:SIBLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OT
Mailing Address - Street 1:1701 AVENUE E STE A
Mailing Address - Street 2:
Mailing Address - City:BILLINGS
Mailing Address - State:MT
Mailing Address - Zip Code:59102-2943
Mailing Address - Country:US
Mailing Address - Phone:406-290-6996
Mailing Address - Fax:406-206-5262
Practice Address - Street 1:1701 AVENUE E STE A
Practice Address - Street 2:
Practice Address - City:BILLINGS
Practice Address - State:MT
Practice Address - Zip Code:59102-2943
Practice Address - Country:US
Practice Address - Phone:406-690-6996
Practice Address - Fax:406-206-5262
Is Sole Proprietor?:No
Enumeration Date:2020-01-28
Last Update Date:2020-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist