Provider Demographics
NPI:1922567254
Name:TREADAWAY, MICHAEL BRADLEY (OTR/L)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:BRADLEY
Last Name:TREADAWAY
Suffix:
Gender:M
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 1:101 S RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:RAINBOW CITY
Mailing Address - State:AL
Mailing Address - Zip Code:35906-3651
Mailing Address - Country:US
Mailing Address - Phone:256-899-9136
Mailing Address - Fax:
Practice Address - Street 1:101 S RIDGE RD
Practice Address - Street 2:
Practice Address - City:RAINBOW CITY
Practice Address - State:AL
Practice Address - Zip Code:35906-3651
Practice Address - Country:US
Practice Address - Phone:256-899-9136
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-16
Last Update Date:2020-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL4157225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty