Provider Demographics
NPI:1841003100
Name:BRADEL, DANIELLE (CTRS)
Entity type:Individual
Prefix:
First Name:DANIELLE
Middle Name:
Last Name:BRADEL
Suffix:
Gender:F
Credentials:CTRS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10817 W 133RD ST
Mailing Address - Street 2:
Mailing Address - City:ORLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60467-1291
Mailing Address - Country:US
Mailing Address - Phone:773-756-6150
Mailing Address - Fax:
Practice Address - Street 1:10817 W 133RD ST
Practice Address - Street 2:
Practice Address - City:ORLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60467-1291
Practice Address - Country:US
Practice Address - Phone:773-756-6150
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-30
Last Update Date:2025-03-07
Deactivation Date:2025-02-18
Deactivation Code:
Reactivation Date:2025-03-06
Provider Licenses
StateLicense IDTaxonomies
IL86923225800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225800000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRecreation Therapist