Provider Demographics
NPI:1497370985
Name:FRASER, BRAD MICHAEL (ATC)
Entity Type:Individual
Prefix:
First Name:BRAD
Middle Name:MICHAEL
Last Name:FRASER
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1862 CRESWELL DR
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45240-1535
Mailing Address - Country:US
Mailing Address - Phone:513-235-3065
Mailing Address - Fax:
Practice Address - Street 1:8800 HOLDEN BLVD
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:OH
Practice Address - Zip Code:45014-2100
Practice Address - Country:US
Practice Address - Phone:513-235-3065
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-10
Last Update Date:2020-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0046922255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer