Provider Demographics
NPI:1447701636
Name:MADSEN, BETH (COTA/L)
Entity type:Individual
Prefix:
First Name:BETH
Middle Name:
Last Name:MADSEN
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20708 SNUG CREEK CT
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33498-6824
Mailing Address - Country:US
Mailing Address - Phone:954-254-4715
Mailing Address - Fax:
Practice Address - Street 1:20708 SNUG CREEK CT
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33498-6824
Practice Address - Country:US
Practice Address - Phone:954-254-4715
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-22
Last Update Date:2016-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOTA 25210224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant