Provider Demographics
NPI:1699258277
Name:BRATCHER, MICHAEL EDWARD (MSOT OTR/L)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:EDWARD
Last Name:BRATCHER
Suffix:
Gender:M
Credentials:MSOT OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3625 SAINT JOSEPH RD
Mailing Address - Street 2:
Mailing Address - City:NEW ALBANY
Mailing Address - State:IN
Mailing Address - Zip Code:47150-9745
Mailing Address - Country:US
Mailing Address - Phone:812-948-0670
Mailing Address - Fax:
Practice Address - Street 1:3625 SAINT JOSEPH RD
Practice Address - Street 2:
Practice Address - City:NEW ALBANY
Practice Address - State:IN
Practice Address - Zip Code:47150-9745
Practice Address - Country:US
Practice Address - Phone:812-948-0670
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-10
Last Update Date:2018-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN31004884A225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT$$$$$$$$$Medicaid