Provider Demographics
NPI:1912725193
Name:SAVAGE, MADISON BAILEY (OTD, OTR/L)
Entity type:Individual
Prefix:DR
First Name:MADISON
Middle Name:BAILEY
Last Name:SAVAGE
Suffix:
Gender:F
Credentials:OTD, OTR/L
Other - Prefix:MISS
Other - First Name:MADISON
Other - Middle Name:BAILEY
Other - Last Name:VANGINHOVEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1380 ARCHER AVE
Mailing Address - Street 2:
Mailing Address - City:MAMMOTH SPRING
Mailing Address - State:AR
Mailing Address - Zip Code:72554-8067
Mailing Address - Country:US
Mailing Address - Phone:870-371-3004
Mailing Address - Fax:
Practice Address - Street 1:205 E TRISH KNIGHT ST
Practice Address - Street 2:SUITE 1
Practice Address - City:WEST PLAINS
Practice Address - State:MO
Practice Address - Zip Code:65775
Practice Address - Country:US
Practice Address - Phone:573-883-6761
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-27
Last Update Date:2024-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2024039179225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist