Provider Demographics
NPI:1316820673
Name:IRWIN, BRADY (OTR)
Entity type:Individual
Prefix:
First Name:BRADY
Middle Name:
Last Name:IRWIN
Suffix:
Gender:X
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19403 ROCK POINTE WAY APT C202
Mailing Address - Street 2:
Mailing Address - City:LANNON
Mailing Address - State:WI
Mailing Address - Zip Code:53046-0070
Mailing Address - Country:US
Mailing Address - Phone:779-221-5791
Mailing Address - Fax:
Practice Address - Street 1:17280 W NORTH AVE
Practice Address - Street 2:
Practice Address - City:BROOKFIELD
Practice Address - State:WI
Practice Address - Zip Code:53045-4366
Practice Address - Country:US
Practice Address - Phone:262-928-8830
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-25
Last Update Date:2025-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI8685-26225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics