Provider Demographics
NPI:1003320300
Name:HATFIELD, BRADLEY ROBERT (MT-BC)
Entity Type:Individual
Prefix:
First Name:BRADLEY
Middle Name:ROBERT
Last Name:HATFIELD
Suffix:
Gender:M
Credentials:MT-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3588 PLYMOUTH RD # 393
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48105-2603
Mailing Address - Country:US
Mailing Address - Phone:734-352-3543
Mailing Address - Fax:
Practice Address - Street 1:2319 WALTER DR
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48103-3452
Practice Address - Country:US
Practice Address - Phone:810-623-0194
Practice Address - Fax:810-623-0194
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-22
Last Update Date:2017-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI225A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic Therapist