Provider Demographics
NPI:1619701232
Name:DELONG, MADISON MARIE
Entity type:Individual
Prefix:
First Name:MADISON
Middle Name:MARIE
Last Name:DELONG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 KEATS DR
Mailing Address - Street 2:
Mailing Address - City:CLAYMONT
Mailing Address - State:DE
Mailing Address - Zip Code:19703-1514
Mailing Address - Country:US
Mailing Address - Phone:302-750-5213
Mailing Address - Fax:
Practice Address - Street 1:77 W BALTIMORE PIKE STE 100B
Practice Address - Street 2:
Practice Address - City:MEDIA
Practice Address - State:PA
Practice Address - Zip Code:19063-5639
Practice Address - Country:US
Practice Address - Phone:610-572-5520
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-27
Last Update Date:2024-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist