Provider Demographics
NPI:1861127706
Name:HARRAH, MADISON REINA (OTR/L)
Entity type:Individual
Prefix:
First Name:MADISON
Middle Name:REINA
Last Name:HARRAH
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:MADISON
Other - Middle Name:REINA
Other - Last Name:HERRIG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3408 14TH ST NE
Mailing Address - Street 2:
Mailing Address - City:GREAT FALLS
Mailing Address - State:MT
Mailing Address - Zip Code:59404-1291
Mailing Address - Country:US
Mailing Address - Phone:913-775-3275
Mailing Address - Fax:
Practice Address - Street 1:3408 14TH ST NE
Practice Address - Street 2:
Practice Address - City:GREAT FALLS
Practice Address - State:MT
Practice Address - Zip Code:59404-1291
Practice Address - Country:US
Practice Address - Phone:913-775-3275
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-22
Last Update Date:2022-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS17-03553225X00000X
MTOTP-OT-LIC-9444225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist