Provider Demographics
NPI:1245088210
Name:HENSLEY, BRADEN
Entity type:Individual
Prefix:
First Name:BRADEN
Middle Name:
Last Name:HENSLEY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9124 ELM CIR
Mailing Address - Street 2:
Mailing Address - City:WINDHAM
Mailing Address - State:OH
Mailing Address - Zip Code:44288-1417
Mailing Address - Country:US
Mailing Address - Phone:330-839-5736
Mailing Address - Fax:
Practice Address - Street 1:9124 ELM CIR
Practice Address - Street 2:
Practice Address - City:WINDHAM
Practice Address - State:OH
Practice Address - Zip Code:44288-1417
Practice Address - Country:US
Practice Address - Phone:330-839-5736
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-07
Last Update Date:2024-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
343900000X, 347C00000X, 3747P1801X, 376J00000X
OH005055175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
No347C00000XTransportation ServicesPrivate Vehicle
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
No376J00000XNursing Service Related ProvidersHomemaker