MEDICARE: MRS. DENISE BRADEN OT

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	5201000209	MI

General Provider Information

NPI Number	:	1386767580
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. DENISE BRADEN OT

Provider Business Mailing Address
First Line	:	1422 N MONROE ST
Second Line	:
City	:	MONROE
State	:	MI
Zip	:	48162-4211
Country	:	US
Telephone Number	:	734-243-0300
Fax Number	:	734-243-3066

Provider Business Practice Location Address
First Line	:	1422 N MONROE ST
Second Line	:
City	:	MONROE
State	:	MI
Zip	:	48162-4211
Country	:	US
Telephone Number	:	734-243-0300
Fax Number	:	734-243-3066

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

Provider Enumeration Date	:	04/10/2007
Last Update Date	:	07/08/2007

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