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General NPI Number Information
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NPI Number | 1104706183
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Entity Type | Individual
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Provider Name | MS. MADELINE GRACE BRAUNIUS
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Gender | Female
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Dates
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Enumeration Date | 09/02/2025
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Last Update Date | 09/02/2025
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Provider Practice Location Address
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Address Line | 2755 STATE HIGHWAY 67
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City | JOHNSTOWN
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State | NY
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Zip | 12095-3747
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Country | US
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Telephone | 518-736-4681
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 658
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City | LAKE PLEASANT
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State | NY
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Zip | 12108-0658
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 030437
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License Number State | NY
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