Provider Demographics
NPI:1699561621
Name:MADSEN, ASHLEY FAYE
Entity type:Individual
Prefix:
First Name:ASHLEY
Middle Name:FAYE
Last Name:MADSEN
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 1:21380 455TH AVE
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:SD
Mailing Address - Zip Code:57212-6204
Mailing Address - Country:US
Mailing Address - Phone:507-820-0780
Mailing Address - Fax:
Practice Address - Street 1:411 CALUMET AVE NW
Practice Address - Street 2:
Practice Address - City:DE SMET
Practice Address - State:SD
Practice Address - Zip Code:57231-2114
Practice Address - Country:US
Practice Address - Phone:605-910-0840
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-16
Last Update Date:2025-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD465A224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant