Provider Demographics
NPI:1861037350
Name:STAVLO, MADELINE BREANNA (OTR/L)
Entity type:Individual
Prefix:
First Name:MADELINE
Middle Name:BREANNA
Last Name:STAVLO
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:MADELINE
Other - Middle Name:
Other - Last Name:HETTINGER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR/L
Mailing Address - Street 1:1108 N MANTORVILLE AVE
Mailing Address - Street 2:
Mailing Address - City:KASSON
Mailing Address - State:MN
Mailing Address - Zip Code:55944-1617
Mailing Address - Country:US
Mailing Address - Phone:507-424-3234
Mailing Address - Fax:
Practice Address - Street 1:1108 N MANTORVILLE AVE
Practice Address - Street 2:
Practice Address - City:KASSON
Practice Address - State:MN
Practice Address - Zip Code:55944-1617
Practice Address - Country:US
Practice Address - Phone:507-424-3234
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-08
Last Update Date:2025-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner