Provider Demographics
NPI:1942988795
Name:HARGIS, MADISON BAYLEE
Entity Type:Individual
Prefix:
First Name:MADISON
Middle Name:BAYLEE
Last Name:HARGIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1758 W LAKEAIRE DR
Mailing Address - Street 2:
Mailing Address - City:MUSTANG
Mailing Address - State:OK
Mailing Address - Zip Code:73064-1117
Mailing Address - Country:US
Mailing Address - Phone:405-596-3141
Mailing Address - Fax:
Practice Address - Street 1:9201 S I 35 SERVICE RD
Practice Address - Street 2:
Practice Address - City:MOORE
Practice Address - State:OK
Practice Address - Zip Code:73160-9046
Practice Address - Country:US
Practice Address - Phone:405-601-4303
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-10
Last Update Date:2023-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant