Provider Demographics
NPI:1417767286
Name:TREADWAY, MICHAL (OTR/L)
Entity type:Individual
Prefix:
First Name:MICHAL
Middle Name:
Last Name:TREADWAY
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 1:232 BOONESBORO RD
Mailing Address - Street 2:
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37615-4201
Mailing Address - Country:US
Mailing Address - Phone:630-962-2023
Mailing Address - Fax:
Practice Address - Street 1:525 W OAKLAND AVE STE 205
Practice Address - Street 2:
Practice Address - City:JOHNSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37604-1673
Practice Address - Country:US
Practice Address - Phone:423-282-1700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-13
Last Update Date:2025-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN8225225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics