Provider Demographics
NPI:1770898520
Name:WASHINGTON, MADELYN PRISCILLA (OCCUPATIONAL THERAPI)
Entity type:Individual
Prefix:MS
First Name:MADELYN
Middle Name:PRISCILLA
Last Name:WASHINGTON
Suffix:
Gender:F
Credentials:OCCUPATIONAL THERAPI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:235TH BSB BOX 215 CMR 463
Mailing Address - Street 2:
Mailing Address - City:APO
Mailing Address - State:AE
Mailing Address - Zip Code:09177-8614
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:CMR 411 BLDG 700 UNIT 28038
Practice Address - Street 2:USAMEDDAC BAVARIA
Practice Address - City:APO
Practice Address - State:AE
Practice Address - Zip Code:09112
Practice Address - Country:US
Practice Address - Phone:49966-283-4721
Practice Address - Fax:49966-283-4721
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-17
Last Update Date:2010-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5201006825174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist