Provider Demographics
NPI:1356447049
Name:MICHELSON, BRADLEY KEITH (OTR)
Entity type:Individual
Prefix:
First Name:BRADLEY
Middle Name:KEITH
Last Name:MICHELSON
Suffix:
Gender:M
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2301 STEINDLER WAY STE B
Mailing Address - Street 2:
Mailing Address - City:NORTH LIBERTY
Mailing Address - State:IA
Mailing Address - Zip Code:52317-7908
Mailing Address - Country:US
Mailing Address - Phone:319-338-3606
Mailing Address - Fax:319-338-0522
Practice Address - Street 1:2301 STEINDLER WAY STE B
Practice Address - Street 2:
Practice Address - City:NORTH LIBERTY
Practice Address - State:IA
Practice Address - Zip Code:52317-7908
Practice Address - Country:US
Practice Address - Phone:319-338-3606
Practice Address - Fax:319-338-0522
Is Sole Proprietor?:No
Enumeration Date:2006-09-16
Last Update Date:2025-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA00592225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0665430Medicaid
IA166543Medicare ID - Type Unspecified