Individual
MARY R BRAYTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MS, OTR
Contact information
Practice address
112 E 5TH AVE, ANTIGO, WI 54409-2710
(715) 623-9469
Mailing address
N6291 STATE HIGHWAY 55, WHITE LAKE, WI 54491-9632
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
1737-026
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1737-026
OT STATE LICENSURE
WI
05
—
40611300
—
WI
Enumeration date
03/21/2007
Last updated
07/09/2007
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