Provider Demographics
NPI:1730751009
Name:BEAIRD, MADISON (COTA)
Entity type:Individual
Prefix:
First Name:MADISON
Middle Name:
Last Name:BEAIRD
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:MADISON
Other - Middle Name:
Other - Last Name:YARBRO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:COTA
Mailing Address - Street 1:14510 US-79
Mailing Address - Street 2:
Mailing Address - City:MCKENZIE
Mailing Address - State:TN
Mailing Address - Zip Code:38201
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:14510 US-79
Practice Address - Street 2:
Practice Address - City:MCKENZIE
Practice Address - State:TN
Practice Address - Zip Code:38201
Practice Address - Country:US
Practice Address - Phone:731-352-5317
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-15
Last Update Date:2021-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN3155224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant