Provider Demographics
NPI:1639752280
Name:PERRY, BRADEN (OT R/L)
Entity Type:Individual
Prefix:
First Name:BRADEN
Middle Name:
Last Name:PERRY
Suffix:
Gender:M
Credentials:OT R/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:46 W 1425 S
Mailing Address - Street 2:
Mailing Address - City:PERRY
Mailing Address - State:UT
Mailing Address - Zip Code:84302-3100
Mailing Address - Country:US
Mailing Address - Phone:435-279-3266
Mailing Address - Fax:
Practice Address - Street 1:46 W 1425 S
Practice Address - Street 2:
Practice Address - City:PERRY
Practice Address - State:UT
Practice Address - Zip Code:84302-3100
Practice Address - Country:US
Practice Address - Phone:435-279-3266
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-02
Last Update Date:2021-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist