Provider Demographics
NPI:1336948280
Name:PITZL, MADDISON RYLIE
Entity type:Individual
Prefix:
First Name:MADDISON
Middle Name:RYLIE
Last Name:PITZL
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18750 WILLAMETTE DR STE F
Mailing Address - Street 2:
Mailing Address - City:WEST LINN
Mailing Address - State:OR
Mailing Address - Zip Code:97068-1700
Mailing Address - Country:US
Mailing Address - Phone:503-833-2649
Mailing Address - Fax:
Practice Address - Street 1:18750 WILLAMETTE DR STE F
Practice Address - Street 2:
Practice Address - City:WEST LINN
Practice Address - State:OR
Practice Address - Zip Code:97068-1700
Practice Address - Country:US
Practice Address - Phone:503-833-2649
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-12
Last Update Date:2025-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR765784246Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246Z00000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, Other