Basic Information
Provider Information
NPI: 1083959878
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: BRADY
FirstName: LINDSAY
MiddleName: MARIE
NamePrefix: MRS.
NameSuffix:  
Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 1741 ASHLAND AVE
Address2:  
City: BALTIMORE
State: MD
PostalCode: 212051531
CountryCode: US
TelephoneNumber:  
FaxNumber:  
Practice Location
Address1: 707 N BROADWAY
Address2:  
City: BALTIMORE
State: MD
PostalCode: 212051832
CountryCode: US
TelephoneNumber: 4439239200
FaxNumber:  
Other Information
ProviderEnumerationDate: 12/05/2012
LastUpdateDate: 10/20/2021
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 10/20/2021

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
225XP0200X06106MDY Respiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics

No ID Information.


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