Provider Demographics
NPI:1457959710
Name:MCELROY, MADISON FAKOURI (MOT, OTR/L)
Entity Type:Individual
Prefix:MS
First Name:MADISON
Middle Name:FAKOURI
Last Name:MCELROY
Suffix:
Gender:F
Credentials:MOT, OTR/L
Other - Prefix:
Other - First Name:MADISON
Other - Middle Name:ALEXANDRA
Other - Last Name:FAKOURI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MOT, OTR/L
Mailing Address - Street 1:P.O. BOX 1480
Mailing Address - Street 2:
Mailing Address - City:PRAIRIEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70769
Mailing Address - Country:US
Mailing Address - Phone:225-255-2638
Mailing Address - Fax:225-771-8093
Practice Address - Street 1:9755 GOODWOOD BLVD
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70815-4514
Practice Address - Country:US
Practice Address - Phone:225-255-2638
Practice Address - Fax:225-771-8093
Is Sole Proprietor?:No
Enumeration Date:2020-10-09
Last Update Date:2024-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX121234225X00000X, 225XP0200X
LA332852225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist