Provider Demographics
NPI:1770344913
Name:RISKI, MADISON (MS)
Entity type:Individual
Prefix:
First Name:MADISON
Middle Name:
Last Name:RISKI
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8325 HEWLETT RD
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30350-3506
Mailing Address - Country:US
Mailing Address - Phone:678-438-9043
Mailing Address - Fax:
Practice Address - Street 1:110 PIPEMAKERS CIR
Practice Address - Street 2:
Practice Address - City:POOLER
Practice Address - State:GA
Practice Address - Zip Code:31322-4167
Practice Address - Country:US
Practice Address - Phone:912-988-1526
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-16
Last Update Date:2024-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics