Provider Demographics
NPI:1558154336
Name:THOMAS, MADISON (OTRL)
Entity type:Individual
Prefix:
First Name:MADISON
Middle Name:
Last Name:THOMAS
Suffix:
Gender:X
Credentials:OTRL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2145 HEIDI DR
Mailing Address - Street 2:
Mailing Address - City:OXFORD
Mailing Address - State:MI
Mailing Address - Zip Code:48370-2812
Mailing Address - Country:US
Mailing Address - Phone:248-408-4944
Mailing Address - Fax:
Practice Address - Street 1:21500 HAGGERTY RD STE 160
Practice Address - Street 2:
Practice Address - City:NORTHVILLE
Practice Address - State:MI
Practice Address - Zip Code:48167-8992
Practice Address - Country:US
Practice Address - Phone:855-413-2225
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-26
Last Update Date:2025-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist