Provider Demographics
NPI:1801773825
Name:DIETZ, MADISON KATE (OTR/L)
Entity type:Individual
Prefix:
First Name:MADISON
Middle Name:KATE
Last Name:DIETZ
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 1:1335 ROSEBUD CT
Mailing Address - Street 2:
Mailing Address - City:WAYNESVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:45068-8350
Mailing Address - Country:US
Mailing Address - Phone:937-681-6998
Mailing Address - Fax:
Practice Address - Street 1:4704 MILLER RD
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:OH
Practice Address - Zip Code:45042-2728
Practice Address - Country:US
Practice Address - Phone:513-420-4559
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-20
Last Update Date:2025-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOT013421225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist