Provider Demographics
NPI:1528821246
Name:NGUYEN, MADISEN (OT)
Entity type:Individual
Prefix:
First Name:MADISEN
Middle Name:
Last Name:NGUYEN
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2921 CHELSEA WOODS DR
Mailing Address - Street 2:
Mailing Address - City:VALRICO
Mailing Address - State:FL
Mailing Address - Zip Code:33596-5204
Mailing Address - Country:US
Mailing Address - Phone:352-232-1246
Mailing Address - Fax:813-779-1879
Practice Address - Street 1:13540 17TH ST
Practice Address - Street 2:
Practice Address - City:DADE CITY
Practice Address - State:FL
Practice Address - Zip Code:33525-5244
Practice Address - Country:US
Practice Address - Phone:352-437-5151
Practice Address - Fax:813-212-3870
Is Sole Proprietor?:No
Enumeration Date:2024-02-05
Last Update Date:2024-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT24936225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist