Provider Demographics
NPI:1609693555
Name:SNETHEN, MADISON (OTD, OTR)
Entity type:Individual
Prefix:
First Name:MADISON
Middle Name:
Last Name:SNETHEN
Suffix:
Gender:F
Credentials:OTD, OTR
Other - Prefix:
Other - First Name:MADISON
Other - Middle Name:
Other - Last Name:BURTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:19251 PRESTON RD APT 2402
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75252-8524
Mailing Address - Country:US
Mailing Address - Phone:979-436-8933
Mailing Address - Fax:
Practice Address - Street 1:11330 LEGACY DR STE 306
Practice Address - Street 2:
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75033-1217
Practice Address - Country:US
Practice Address - Phone:469-297-6340
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-23
Last Update Date:2024-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX125009225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist