Provider Demographics
NPI:1902084346
Name:BRADEN, AMANDA J (OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:J
Last Name:BRADEN
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:N2195 BEECH BLVD
Mailing Address - Street 2:
Mailing Address - City:LAKE GENEVA
Mailing Address - State:WI
Mailing Address - Zip Code:53147-4424
Mailing Address - Country:US
Mailing Address - Phone:262-206-1567
Mailing Address - Fax:262-248-9479
Practice Address - Street 1:N2195 BEECH BLVD
Practice Address - Street 2:
Practice Address - City:LAKE GENEVA
Practice Address - State:WI
Practice Address - Zip Code:53147-4424
Practice Address - Country:US
Practice Address - Phone:262-206-1567
Practice Address - Fax:262-248-9479
Is Sole Proprietor?:No
Enumeration Date:2008-02-07
Last Update Date:2008-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0056-007841171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor