Provider Demographics
NPI:1134844798
Name:LAND, MADISON NICOLE (OTR/L)
Entity type:Individual
Prefix:
First Name:MADISON
Middle Name:NICOLE
Last Name:LAND
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:270 CONIFER WAY
Mailing Address - Street 2:
Mailing Address - City:SHELBY
Mailing Address - State:NC
Mailing Address - Zip Code:28150-7302
Mailing Address - Country:US
Mailing Address - Phone:828-506-5701
Mailing Address - Fax:980-701-0008
Practice Address - Street 1:803 N LAUREL ST
Practice Address - Street 2:
Practice Address - City:LINCOLNTON
Practice Address - State:NC
Practice Address - Zip Code:28092-2921
Practice Address - Country:US
Practice Address - Phone:980-241-5361
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-06
Last Update Date:2024-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC15449225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist