Blair Ellyse Madkins, COTA/L, BS, AAS

Primary specialty

Occupational Therapy AssistantTaxonomy code 224Z00000X

License

216479 Issued in TX

Practice address

14248 Chaps Dr
Dallas, TX 75253-5305

Phone

(936) 371-3094

NPI assigned

Sep 25, 2020

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Associate of Applied Science, Bachelor of Science

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1600992000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1600992000000",
    "number": "1164039970",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14248 CHAPS DR",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752535305",
            "telephone_number": "936-371-3094"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14248 CHAPS DR",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752535305",
            "telephone_number": "936-371-3094"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MADKINS",
        "first_name": "BLAIR",
        "middle_name": "ELLYSE",
        "credential": "COTA/L, BS, AAS",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2020-09-25",
        "last_updated": "2020-09-25",
        "certification_date": "2020-09-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "224Z00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Occupational Therapy Assistant",
            "state": "TX",
            "license": "216479",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TEXAS BOARD OF OCCUPATIONAL THERAPY EXAMINERS",
            "identifier": "216479",
            "state": "TX"
        }
    ],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "DALLAS",
            "affiliation": "N",
            "address_1": "14248 Chaps Dr",
            "city": "Dallas",
            "state": "TX",
            "country_code": "US",
            "postal_code": "752535305",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Amanda D Madison, FNP
• Gail A Madison, PA-C
• Kimberly Madison, NURSE PRACTITIONER
• Kyle Madison, MD
• Hamid Reza Kashani Madjd, D.D.S.
• Dina Itum Madni, MD
• Madorcare
• Margarita Madrid, PNP-BC
• Elizabeth Madrigal, PTA
• Silvia Madrigal, NP

• Occupational Therapy Assistant in Dallas, TX
• Providers in Dallas, TX by specialty
• Occupational Therapy Assistant in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 25, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.