Provider Demographics
NPI:1801001631
Name:BRAGDON-PLACE, MICHELLE A (OTR-L)
Entity Type:Individual
Prefix:MS
First Name:MICHELLE
Middle Name:A
Last Name:BRAGDON-PLACE
Suffix:
Gender:F
Credentials:OTR-L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 SARAH WAY
Mailing Address - Street 2:
Mailing Address - City:NEWTON
Mailing Address - State:NH
Mailing Address - Zip Code:03858-3426
Mailing Address - Country:US
Mailing Address - Phone:603-378-0140
Mailing Address - Fax:603-974-0779
Practice Address - Street 1:6 SARAH WAY
Practice Address - Street 2:
Practice Address - City:NEWTON
Practice Address - State:NH
Practice Address - Zip Code:03858-3426
Practice Address - Country:US
Practice Address - Phone:603-378-0140
Practice Address - Fax:603-974-0779
Is Sole Proprietor?:No
Enumeration Date:2007-05-14
Last Update Date:2010-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH1699225X00000X
MA8702225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0325929Medicaid
NH30413322Medicaid