Provider Demographics
NPI:1609602382
Name:PICKERING, MADDISON P (OTR/L)
Entity type:Individual
Prefix:
First Name:MADDISON
Middle Name:P
Last Name:PICKERING
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7428 COUNTY ROAD 12
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:NY
Mailing Address - Zip Code:14512-9209
Mailing Address - Country:US
Mailing Address - Phone:585-208-9877
Mailing Address - Fax:
Practice Address - Street 1:240 NORTH AVE
Practice Address - Street 2:
Practice Address - City:PENN YAN
Practice Address - State:NY
Practice Address - Zip Code:14527-1052
Practice Address - Country:US
Practice Address - Phone:315-694-7676
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-10
Last Update Date:2024-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY029456225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist