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Certified Provider Details:
| PROVIDER NUMBER: | 490078 |
| AGENCY NAME: | Braley & Thompson, Inc. |
| CONTACT NAME: | Barbara Recknagel |
| ADDRESS: | PO Box 484 |
| CITY: | Dunbar |
| STATE: | WV |
| ZIP: | 25064 |
| PHONE: | |
| WEB SITE: | |
| EMAIL ADDRESS: | suzun-carpenter@btkids.biz |
| BSW/MSW NAME: | Barbara Recknagel |
| DUE TO RECERTIFY DATE: | 7/1/2012 |
| COMMENTS: |