Healthcare Provider Details

I. General information

NPI: 1124601349
Provider Name (Legal Business Name): BRADY EGGLESTON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/05/2021
Last Update Date: 07/02/2026
Certification Date: 07/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2251 E PARIS AVE SE
GRAND RAPIDS MI
49546-2431
US

IV. Provider business mailing address

2251 E PARIS AVE SE
GRAND RAPIDS MI
49546-2431
US

V. Phone/Fax

Practice location:
  • Phone: 616-447-7799
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number5201014488
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: