Provider Demographics
NPI:1427542703
Name:ANDERSON, MADISON SUZANNE (OT, MOT)
Entity type:Individual
Prefix:
First Name:MADISON
Middle Name:SUZANNE
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:OT, MOT
Other - Prefix:
Other - First Name:MADISON
Other - Middle Name:SUZANNE
Other - Last Name:ZUBRADT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OT, MOT
Mailing Address - Street 1:6397 LEE HWY STE 300
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37421-2564
Mailing Address - Country:US
Mailing Address - Phone:423-238-7217
Mailing Address - Fax:423-238-3473
Practice Address - Street 1:10801 E STATE ROUTE 350 STE B
Practice Address - Street 2:
Practice Address - City:RAYTOWN
Practice Address - State:MO
Practice Address - Zip Code:64138
Practice Address - Country:US
Practice Address - Phone:816-737-5500
Practice Address - Fax:816-737-5504
Is Sole Proprietor?:No
Enumeration Date:2018-06-19
Last Update Date:2019-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS17-03456225X00000X
MO2018028563225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist