Individual
BRAXTYN MICHAEL RADER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
719 SPENCER ST, LOGANSPORT, IN 46947-3583
(574) 398-0146
Mailing address
719 SPENCER ST, LOGANSPORT, IN 46947-3583
(574) 398-0146
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
RBT-25-481003
BACB
IN
Enumeration date
10/13/2025
Last updated
10/13/2025
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