Provider Demographics
NPI:1811002470
Name:BRADY, MARY K (OT)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:K
Last Name:BRADY
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3525 LOMA VISTA RD
Mailing Address - Street 2:
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93003-3101
Mailing Address - Country:US
Mailing Address - Phone:805-641-6415
Mailing Address - Fax:805-641-6424
Practice Address - Street 1:3525 LOMA VISTA RD
Practice Address - Street 2:
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93003-3101
Practice Address - Country:US
Practice Address - Phone:805-641-6415
Practice Address - Fax:805-641-6424
Is Sole Proprietor?:No
Enumeration Date:2006-08-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOT 7546225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWOT7546BMedicare ID - Type Unspecified