MEDICARE: BRIAN BRADY O.T.

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	OT 10390	FL

General Provider Information

NPI Number	:	1386943637
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRIAN BRADY O.T.

Provider Business Mailing Address
First Line	:	2042 SW BEARD ST
Second Line	:
City	:	PORT ST LUCIE
State	:	FL
Zip	:	34953-1735
Country	:	US
Telephone Number	:	772-249-5269
Fax Number	:

Provider Business Practice Location Address
First Line	:	2042 SW BEARD ST
Second Line	:
City	:	PORT ST LUCIE
State	:	FL
Zip	:	34953-1735
Country	:	US
Telephone Number	:	772-249-5269
Fax Number	:

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

Provider Enumeration Date	:	03/24/2011
Last Update Date	:	11/04/2024

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