Provider Demographics
NPI:1427833920
Name:SLESK, MADISON BROOKE (COTA/L)
Entity type:Individual
Prefix:
First Name:MADISON
Middle Name:BROOKE
Last Name:SLESK
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:MADISON
Other - Middle Name:BROOKE
Other - Last Name:STEVENS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:690 32ND ST APT 210
Mailing Address - Street 2:
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98225-6925
Mailing Address - Country:US
Mailing Address - Phone:801-472-8283
Mailing Address - Fax:
Practice Address - Street 1:930 E SOUTHERN AVE
Practice Address - Street 2:
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85282
Practice Address - Country:US
Practice Address - Phone:480-456-0719
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-31
Last Update Date:2023-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZOTA-047277224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant