Provider Demographics
NPI:1417784091
Name:LAMP, MADISEN (OTR/L)
Entity type:Individual
Prefix:
First Name:MADISEN
Middle Name:
Last Name:LAMP
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 1:3844 RIVIERA RD
Mailing Address - Street 2:
Mailing Address - City:SARTELL
Mailing Address - State:MN
Mailing Address - Zip Code:56377-9764
Mailing Address - Country:US
Mailing Address - Phone:952-388-4320
Mailing Address - Fax:
Practice Address - Street 1:2835 W SAINT GERMAIN ST STE 300
Practice Address - Street 2:
Practice Address - City:SAINT CLOUD
Practice Address - State:MN
Practice Address - Zip Code:56301-6281
Practice Address - Country:US
Practice Address - Phone:952-388-4320
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-17
Last Update Date:2024-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist