Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224Z00000X | Occupational Therapy Assistant | 006887-1 | NY |
NPI | 1033315585 |
---|---|
Provider Name | Nicole Bradley |
First Address | Middletown, NY 10941-1001 |
Second Address | Highland, NY 12528-2143 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/06/2007 |
Last Update Date | 08/07/2007 |