Provider Demographics
NPI:1053149880
Name:BECK, MADISON TAELOR (OTR/L)
Entity type:Individual
Prefix:
First Name:MADISON
Middle Name:TAELOR
Last Name:BECK
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:127 N ELIZABETH ST APT 207
Mailing Address - Street 2:
Mailing Address - City:LIMA
Mailing Address - State:OH
Mailing Address - Zip Code:45801-4345
Mailing Address - Country:US
Mailing Address - Phone:412-759-3201
Mailing Address - Fax:
Practice Address - Street 1:3817 COLONEL GLENN HWY
Practice Address - Street 2:
Practice Address - City:BEAVERCREEK
Practice Address - State:OH
Practice Address - Zip Code:45324-2268
Practice Address - Country:US
Practice Address - Phone:937-427-9203
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-23
Last Update Date:2024-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225X00000X
OHOT012972225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics