Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Madilyn Grace Lack, COTA/L

Individual provider Occupational Therapy Assistant · NPI 1134041148

Madilyn Grace Lack, COTA/L is an Occupational Therapy Assistant in Gatewood, Missouri. Practices as a sole proprietor. Licensed in Missouri.

Licensed in
MO
In the registry since
2026
What do these letters mean?
COTA/L — Certified Occupational Therapy Assistant, Licensed
An occupational therapy assistant who is both certified and state licensed.

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Practice location Address checks out

11111 State Highway 142W
Gatewood, MO 63942-7619
Phone: (573) 255-3213
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Occupational Therapy Assistant (primary) Taxonomy 224Z00000X · Licence 2026029031 (MO)

Record details

NPI number1134041148
Entity typeIndividual (Type 1)
GenderFemale
Credentials COTA/L
Sole proprietorYes
NPI enumeratedJuly 29, 2026
Last updated in NPPESJuly 29, 2026
Certification dateJuly 29, 2026