Provider Demographics
NPI:1740958834
Name:PASSAFUMA, MADISON NICOLE
Entity type:Individual
Prefix:
First Name:MADISON
Middle Name:NICOLE
Last Name:PASSAFUMA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3322 KARLEIGH WAY
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:TX
Mailing Address - Zip Code:77406-2558
Mailing Address - Country:US
Mailing Address - Phone:281-415-6353
Mailing Address - Fax:
Practice Address - Street 1:7400 CLAREWOOD DR
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77036-4380
Practice Address - Country:US
Practice Address - Phone:713-774-5821
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-02
Last Update Date:2021-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX217043224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant