Provider Demographics
NPI:1538943238
Name:KURT, MADELINE ELIZABETH (OTR/L)
Entity type:Individual
Prefix:
First Name:MADELINE
Middle Name:ELIZABETH
Last Name:KURT
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 1:220 EAGLE CREST DR
Mailing Address - Street 2:
Mailing Address - City:SOUTH LYON
Mailing Address - State:MI
Mailing Address - Zip Code:48178-2040
Mailing Address - Country:US
Mailing Address - Phone:616-304-4237
Mailing Address - Fax:
Practice Address - Street 1:84 CENTENNIAL LOOP
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-7909
Practice Address - Country:US
Practice Address - Phone:541-255-2681
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-23
Last Update Date:2023-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR498513225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics