Provider Demographics
NPI:1013552868
Name:BRADLEY, BRENDA MARIE (MOT)
Entity Type:Individual
Prefix:
First Name:BRENDA
Middle Name:MARIE
Last Name:BRADLEY
Suffix:
Gender:F
Credentials:MOT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31975 COWAN RD
Mailing Address - Street 2:
Mailing Address - City:WESTLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48185-6945
Mailing Address - Country:US
Mailing Address - Phone:734-673-6438
Mailing Address - Fax:
Practice Address - Street 1:23265 NORTHWESTERN HWY
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48075-7707
Practice Address - Country:US
Practice Address - Phone:833-446-7246
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-14
Last Update Date:2019-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist