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 1:1650 LYNDON FARM CT STE 300
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40223-5005
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6298 VETERANS PKWY STE 5B
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31909-6244
Practice Address - Country:US
Practice Address - Phone:706-225-0380
Practice Address - Fax:706-225-0390
Is Sole Proprietor?:No
Enumeration Date:2006-04-04
Last Update Date:2025-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC7322225XH1200X
GAOT009565225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2514512Medicare PIN