Provider Demographics
NPI:1891387189
Name:MATHEWS, MADISON R (OTR)
Entity type:Individual
Prefix:
First Name:MADISON
Middle Name:R
Last Name:MATHEWS
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:MADISON
Other - Middle Name:R
Other - Last Name:HATFIELD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1405 4TH AVE NW # 296
Mailing Address - Street 2:
Mailing Address - City:ARDMORE
Mailing Address - State:OK
Mailing Address - Zip Code:73401-2708
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:410 W LILLIE BLVD
Practice Address - Street 2:
Practice Address - City:MADILL
Practice Address - State:OK
Practice Address - Zip Code:73446-1270
Practice Address - Country:US
Practice Address - Phone:580-872-4277
Practice Address - Fax:580-872-4261
Is Sole Proprietor?:No
Enumeration Date:2021-02-08
Last Update Date:2025-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2134224Z00000X
OK6103225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant