Provider Demographics
NPI:1699989368
Name:MADISON, VIVIAN YVONNE (OTR)
Entity type:Individual
Prefix:MS
First Name:VIVIAN
Middle Name:YVONNE
Last Name:MADISON
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4863 HUTSON AVE
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35207-1215
Mailing Address - Country:US
Mailing Address - Phone:205-669-7455
Mailing Address - Fax:205-328-5821
Practice Address - Street 1:4863 HUTSON AVE
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35207-1215
Practice Address - Country:US
Practice Address - Phone:205-669-7455
Practice Address - Fax:205-328-5821
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL0050225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist