Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225XP0200X | Occupational Therapist - Pediatrics | 0119004462 | VA |
Y | 225XP0200X | Occupational Therapist - Pediatrics | 6841 | NC |
NPI | 1043431257 |
---|---|
Provider Name | Mrs. Melissa Marie Bradley |
First Address | Charlotte, NC 28204-3057 |
Second Address | Charlotte, NC 28204-3057 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/05/2007 |
Last Update Date | 04/08/2009 |