Provider Demographics
NPI:1043912595
Name:MADDUX, ADELLINE GRACE POSEY (OTR)
Entity type:Individual
Prefix:DR
First Name:ADELLINE
Middle Name:GRACE POSEY
Last Name:MADDUX
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:MS
Other - First Name:ADELLINE
Other - Middle Name:GRACE
Other - Last Name:POSEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1987 E WILKINS PL
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72703-3729
Mailing Address - Country:US
Mailing Address - Phone:870-805-8337
Mailing Address - Fax:
Practice Address - Street 1:1000 W POPLAR ST
Practice Address - Street 2:
Practice Address - City:ROGERS
Practice Address - State:AR
Practice Address - Zip Code:72756-4242
Practice Address - Country:US
Practice Address - Phone:479-631-7678
Practice Address - Fax:479-631-8886
Is Sole Proprietor?:No
Enumeration Date:2023-03-20
Last Update Date:2023-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR489470225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist