Basic Information
| Provider Information | |||||||||
| NPI: | 1992422273 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LUDDY | ||||||||
| FirstName: | MADELYNE | ||||||||
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| Credential: | OTD, OTR/L | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2322 ELMHURST AVE | ||||||||
| Address2: | |||||||||
| City: | ROYAL OAK | ||||||||
| State: | MI | ||||||||
| PostalCode: | 480733861 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2488408508 | ||||||||
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| Practice Location | |||||||||
| Address1: | 28000 WOODWARD AVE | ||||||||
| Address2: | |||||||||
| City: | ROYAL OAK | ||||||||
| State: | MI | ||||||||
| PostalCode: | 480670960 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2483953777 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/26/2022 | ||||||||
| LastUpdateDate: | 10/26/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/26/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225X00000X | 5201013139 | MI | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist |
No ID Information.