Provider Demographics
NPI:1013585363
Name:BRADEN, ALISON RACHEL (OTRL)
Entity Type:Individual
Prefix:
First Name:ALISON
Middle Name:RACHEL
Last Name:BRADEN
Suffix:
Gender:F
Credentials:OTRL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:850 S HEWITT RD STE 100
Mailing Address - Street 2:
Mailing Address - City:YPSILANTI
Mailing Address - State:MI
Mailing Address - Zip Code:48197-4594
Mailing Address - Country:US
Mailing Address - Phone:734-544-5561
Mailing Address - Fax:
Practice Address - Street 1:850 S HEWITT RD STE 100
Practice Address - Street 2:
Practice Address - City:YPSILANTI
Practice Address - State:MI
Practice Address - Zip Code:48197-4594
Practice Address - Country:US
Practice Address - Phone:734-544-5561
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-14
Last Update Date:2023-06-09
Deactivation Date:2023-05-04
Deactivation Code:
Reactivation Date:2023-05-18
Provider Licenses
StateLicense IDTaxonomies
IL056.013646225X00000X
225XP0200X
MI5201010186225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics