Provider Demographics
NPI:1184357337
Name:TATE, MADISON TAYLOR (OTR)
Entity type:Individual
Prefix:
First Name:MADISON
Middle Name:TAYLOR
Last Name:TATE
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3600 SAUNDERS AVE
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23227-4328
Mailing Address - Country:US
Mailing Address - Phone:804-914-4299
Mailing Address - Fax:
Practice Address - Street 1:3600 SAUNDERS AVE
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23227-4328
Practice Address - Country:US
Practice Address - Phone:804-914-4299
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-06
Last Update Date:2022-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics