Provider Demographics
NPI:1497582480
Name:PAINE, MADISON LEE (OTD)
Entity type:Individual
Prefix:
First Name:MADISON
Middle Name:LEE
Last Name:PAINE
Suffix:
Gender:F
Credentials:OTD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:668 W NIX RD
Mailing Address - Street 2:
Mailing Address - City:ROCKPORT
Mailing Address - State:AR
Mailing Address - Zip Code:72104-2194
Mailing Address - Country:US
Mailing Address - Phone:501-538-0484
Mailing Address - Fax:
Practice Address - Street 1:2200 FORT ROOTS DR
Practice Address - Street 2:
Practice Address - City:NORTH LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72114-1709
Practice Address - Country:US
Practice Address - Phone:501-257-3387
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-16
Last Update Date:2024-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AROT2024-024225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist