Provider Demographics
NPI:1982483244
Name:PICHE, MADYSON PAIGE
Entity Type:Individual
Prefix:
First Name:MADYSON
Middle Name:PAIGE
Last Name:PICHE
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 1:3619 E 7 MILE RD
Mailing Address - Street 2:
Mailing Address - City:SAULT SAINTE MARIE
Mailing Address - State:MI
Mailing Address - Zip Code:49783-8636
Mailing Address - Country:US
Mailing Address - Phone:906-440-8180
Mailing Address - Fax:
Practice Address - Street 1:1800 HERITAGE BLVD
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:TX
Practice Address - Zip Code:79707-9750
Practice Address - Country:US
Practice Address - Phone:432-520-1600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-26
Last Update Date:2023-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX124002225XP0019X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0019XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPhysical Rehabilitation