Provider Demographics
NPI:1770545923
Name:BRADY, KRISTEN ELLEN (OT)
Entity type:Individual
Prefix:
First Name:KRISTEN
Middle Name:ELLEN
Last Name:BRADY
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:KRISTEN
Other - Middle Name:ELLEN
Other - Last Name:THOMAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OT
Mailing Address - Street 1:120 WILLIAM PENN PLZ
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27704-2150
Mailing Address - Country:US
Mailing Address - Phone:919-220-5255
Mailing Address - Fax:919-313-1276
Practice Address - Street 1:7850 BRIER CREEK PKWY STE AND300
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27617-8900
Practice Address - Country:US
Practice Address - Phone:919-846-3938
Practice Address - Fax:919-846-3932
Is Sole Proprietor?:No
Enumeration Date:2006-04-04
Last Update Date:2023-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC7322225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2514512Medicare PIN