Provider Demographics
NPI:1295187912
Name:KRIEGEL, BRADEN (OT)
Entity type:Individual
Prefix:
First Name:BRADEN
Middle Name:
Last Name:KRIEGEL
Suffix:
Gender:M
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:118 E HIGHLAND AVE
Mailing Address - Street 2:
Mailing Address - City:ADA
Mailing Address - State:OH
Mailing Address - Zip Code:45810-1120
Mailing Address - Country:US
Mailing Address - Phone:419-634-8655
Mailing Address - Fax:
Practice Address - Street 1:485 MOXIE LN
Practice Address - Street 2:
Practice Address - City:DELPHOS
Practice Address - State:OH
Practice Address - Zip Code:45833-9182
Practice Address - Country:US
Practice Address - Phone:419-692-3401
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-06
Last Update Date:2016-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH007285225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist