Provider Demographics
NPI:1629781091
Name:HARBAUGH, BRADY COVERT (OTRL)
Entity Type:Individual
Prefix:
First Name:BRADY
Middle Name:COVERT
Last Name:HARBAUGH
Suffix:
Gender:F
Credentials:OTRL
Other - Prefix:
Other - First Name:BRADY
Other - Middle Name:KATHLEEN
Other - Last Name:COVERT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4097 CHENLOT LN
Mailing Address - Street 2:
Mailing Address - City:WATERFORD
Mailing Address - State:MI
Mailing Address - Zip Code:48328-4218
Mailing Address - Country:US
Mailing Address - Phone:248-633-4977
Mailing Address - Fax:
Practice Address - Street 1:11012 E 13 MILE RD
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:MI
Practice Address - Zip Code:48093-2572
Practice Address - Country:US
Practice Address - Phone:586-459-5861
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-02
Last Update Date:2023-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5201013184225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist