Provider Demographics
NPI:1710864475
Name:CRANDALL, MADISON NICOLE (OTD)
Entity type:Individual
Prefix:
First Name:MADISON
Middle Name:NICOLE
Last Name:CRANDALL
Suffix:
Gender:F
Credentials:OTD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2099 HARTFORD DR UNIT 27
Mailing Address - Street 2:
Mailing Address - City:CHICO
Mailing Address - State:CA
Mailing Address - Zip Code:95928-6451
Mailing Address - Country:US
Mailing Address - Phone:530-774-4040
Mailing Address - Fax:
Practice Address - Street 1:2550 FLORAL AVE
Practice Address - Street 2:
Practice Address - City:CHICO
Practice Address - State:CA
Practice Address - Zip Code:95973-9368
Practice Address - Country:US
Practice Address - Phone:530-894-0702
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-16
Last Update Date:2025-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA28058225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist