Provider Demographics
NPI:1679087860
Name:BRADY, RACHEL DIANE (MOT, OTR/L)
Entity Type:Individual
Prefix:MISS
First Name:RACHEL
Middle Name:DIANE
Last Name:BRADY
Suffix:
Gender:F
Credentials:MOT, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:128 SUMAC ST APT 1F
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19128-3866
Mailing Address - Country:US
Mailing Address - Phone:423-327-3606
Mailing Address - Fax:
Practice Address - Street 1:254 LANCASTER AVE
Practice Address - Street 2:
Practice Address - City:MALVERN
Practice Address - State:PA
Practice Address - Zip Code:19355-3087
Practice Address - Country:US
Practice Address - Phone:610-525-1000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-27
Last Update Date:2017-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOC014825225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAOC014825OtherPA LICENSE
366295OtherNBCOT