Active NPI
Madalyn Azelle Potterfield
- Occupational Therapy Assistant
- Monroe City, MO
National Provider Identifier
1467029561
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapy Assistant
- License
- 057005150
- Practice address
- 1 Lake Potterfield Dr
Monroe City, MO 63456-1187 - Phone
- (573) 470-9412
- NPI assigned
- Jun 7, 2021
- Last updated
- Jun 7, 2021
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Occupational Therapy Assistant | 224Z00000X | 057005150 | IL | Primary |
Addresses
Primary practice location
1 Lake Potterfield Dr
Monroe City, MO 63456-1187
Mailing address
3170 Highway 61
Hannibal, MO 63401-6571
Phone (573) 221-5533
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 057005150 | IL | MD | Occupational Therapy Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1623024000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1623024000000",
"number": "1467029561",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3170 HIGHWAY 61",
"city": "HANNIBAL",
"state": "MO",
"postal_code": "634016571",
"telephone_number": "573-221-5533"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1 LAKE POTTERFIELD DR",
"city": "MONROE CITY",
"state": "MO",
"postal_code": "634561187",
"telephone_number": "573-470-9412"
}
],
"practiceLocations": [],
"basic": {
"last_name": "POTTERFIELD",
"first_name": "MADALYN",
"middle_name": "AZELLE",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2021-06-07",
"last_updated": "2021-06-07",
"certification_date": "2021-06-07",
"status": "A"
},
"taxonomies": [
{
"code": "224Z00000X",
"taxonomy_group": "",
"desc": "Occupational Therapy Assistant",
"state": "IL",
"license": "057005150",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Monroe City, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 7, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.