MEDICARE: MS. MICHELLE A BRAGDON-PLACE OTR-L

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225X00000X	Occupational Therapist	1699	NH
2	225X00000X	Occupational Therapist	8702	MA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1801001631
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MICHELLE A BRAGDON-PLACE OTR-L

Provider Business Mailing Address
First Line	:	6 SARAH WAY
Second Line	:
City	:	NEWTON
State	:	NH
Zip	:	03858-3426
Country	:	US
Telephone Number	:	603-378-0140
Fax Number	:	603-974-0779

Provider Business Practice Location Address
First Line	:	6 SARAH WAY
Second Line	:
City	:	NEWTON
State	:	NH
Zip	:	03858-3426
Country	:	US
Telephone Number	:	603-378-0140
Fax Number	:	603-974-0779

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/14/2007
Last Update Date	:	05/11/2010

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