Healthcare Provider Details

I. General information

NPI: 1316820673
Provider Name (Legal Business Name): BRADY IRWIN OTR
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/25/2025
Last Update Date: 08/25/2025
Certification Date: 08/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17280 W NORTH AVE
BROOKFIELD WI
53045-4366
US

IV. Provider business mailing address

19403 ROCK POINTE WAY APT C202
LANNON WI
53046-0070
US

V. Phone/Fax

Practice location:
  • Phone: 262-928-8830
  • Fax:
Mailing address:
  • Phone: 779-221-5791
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number8685
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number8685-26
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: