Provider Demographics
NPI:1992342299
Name:BAMFORD, MADELYNN J (OTA, BT TECH)
Entity type:Individual
Prefix:
First Name:MADELYNN
Middle Name:J
Last Name:BAMFORD
Suffix:
Gender:F
Credentials:OTA, BT TECH
Other - Prefix:
Other - First Name:MADELYNN
Other - Middle Name:J
Other - Last Name:SEICHTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:580 N WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:JANESVILLE
Mailing Address - State:WI
Mailing Address - Zip Code:53548-2984
Mailing Address - Country:US
Mailing Address - Phone:608-756-5555
Mailing Address - Fax:608-314-2442
Practice Address - Street 1:580 N WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:JANESVILLE
Practice Address - State:WI
Practice Address - Zip Code:53548-2984
Practice Address - Country:US
Practice Address - Phone:608-756-5555
Practice Address - Fax:608-314-2442
Is Sole Proprietor?:No
Enumeration Date:2019-12-05
Last Update Date:2019-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5390-27224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant