Provider Demographics
NPI:1932799434
Name:HODGES, MADISON (OTR/L)
Entity Type:Individual
Prefix:
First Name:MADISON
Middle Name:
Last Name:HODGES
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:263 MAPLE HOLLOW RD
Mailing Address - Street 2:
Mailing Address - City:MOUNT AIRY
Mailing Address - State:NC
Mailing Address - Zip Code:27030-8745
Mailing Address - Country:US
Mailing Address - Phone:336-930-2466
Mailing Address - Fax:
Practice Address - Street 1:560 JOHNSON RIDGE RD
Practice Address - Street 2:
Practice Address - City:ELKIN
Practice Address - State:NC
Practice Address - Zip Code:28621-2420
Practice Address - Country:US
Practice Address - Phone:336-835-7802
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-19
Last Update Date:2021-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC12255225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist