Provider Demographics
NPI:1639384639
Name:EGAN, BRAD EDWARD (OTD, OTRL)
Entity type:Individual
Prefix:DR
First Name:BRAD
Middle Name:EDWARD
Last Name:EGAN
Suffix:
Gender:M
Credentials:OTD, OTRL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5646 N KENMORE AVE
Mailing Address - Street 2:UNIT 4D
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60660-4621
Mailing Address - Country:US
Mailing Address - Phone:864-266-3130
Mailing Address - Fax:
Practice Address - Street 1:5646 N KENMORE AVE
Practice Address - Street 2:4D
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60660-4621
Practice Address - Country:US
Practice Address - Phone:864-266-3130
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL056006892225X00000X, 225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Not Answered225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics