Provider Demographics
NPI:1013773480
Name:HUME, MADELYN NICOLE (OT)
Entity Type:Individual
Prefix:MRS
First Name:MADELYN
Middle Name:NICOLE
Last Name:HUME
Suffix:
Gender:F
Credentials:OT
Other - Prefix:MISS
Other - First Name:MADELYN
Other - Middle Name:NICOLE
Other - Last Name:BASYE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSOT, OTR/L
Mailing Address - Street 1:2028 LIBERTY RD STE 103
Mailing Address - Street 2:
Mailing Address - City:ELDERSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:21784-5079
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2028 LIBERTY RD STE 103
Practice Address - Street 2:
Practice Address - City:ELDERSBURG
Practice Address - State:MD
Practice Address - Zip Code:21784-5079
Practice Address - Country:US
Practice Address - Phone:410-205-4777
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-23
Last Update Date:2024-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD10172225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist