Active NPI
Brad Menke
- Occupational Therapist
- Evansville, IN
National Provider Identifier
1073535720
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapist
- License
- 31000407A
- Practice address
- 1400 Professional Blvd
Evansville, IN 47714-8004 - Phone
- (812) 485-7121
- Fax
- (812) 485-4735
- NPI assigned
- Jul 24, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Occupational Therapist | 225X00000X | 31000407A | IN | Primary |
Addresses
Primary practice location
1400 Professional Blvd
Evansville, IN 47714-8004
Mailing address
1400 Professional Blvd
Evansville, IN 47714-8004
Phone (812) 485-7121
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 31000407A | IN | MD | Occupational Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1153699200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1488240000000",
"number": "1073535720",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1400 PROFESSIONAL BLVD",
"city": "EVANSVILLE",
"state": "IN",
"postal_code": "477148004",
"telephone_number": "812-485-7121",
"fax_number": "812-485-4735"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1400 PROFESSIONAL BLVD",
"city": "EVANSVILLE",
"state": "IN",
"postal_code": "477148004",
"telephone_number": "812-485-7121",
"fax_number": "812-485-4735"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MENKE",
"first_name": "BRAD",
"name_prefix": "Mr.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-07-24",
"last_updated": "2017-02-28",
"status": "A"
},
"taxonomies": [
{
"code": "225X00000X",
"taxonomy_group": "",
"desc": "Occupational Therapist",
"state": "IN",
"license": "31000407A",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Evansville, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 28, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.