Provider Demographics
NPI:1821578436
Name:AVINA, BRADY LYN (OTR/L)
Entity Type:Individual
Prefix:
First Name:BRADY
Middle Name:LYN
Last Name:AVINA
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:PO BOX 53249
Mailing Address - Street 2:
Mailing Address - City:PETTISVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43553-0249
Mailing Address - Country:US
Mailing Address - Phone:419-822-7764
Mailing Address - Fax:
Practice Address - Street 1:214 S MUNSON RD
Practice Address - Street 2:
Practice Address - City:SWANTON
Practice Address - State:OH
Practice Address - Zip Code:43558-1210
Practice Address - Country:US
Practice Address - Phone:419-825-1145
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-14
Last Update Date:2018-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOT010234225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHOT010234OtherNATIONAL BOARD OF OCCUPATIONAL THERAPY