Provider Demographics
NPI:1073838348
Name:DEANS, BRADLEY JASON (COTA/L)
Entity Type:Individual
Prefix:
First Name:BRADLEY
Middle Name:JASON
Last Name:DEANS
Suffix:
Gender:M
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:302 CHRISTIANA ST
Mailing Address - Street 2:
Mailing Address - City:CRANE
Mailing Address - State:MO
Mailing Address - Zip Code:65633-9107
Mailing Address - Country:US
Mailing Address - Phone:417-844-4252
Mailing Address - Fax:
Practice Address - Street 1:302 CHRISTIANA ST
Practice Address - Street 2:
Practice Address - City:CRANE
Practice Address - State:MO
Practice Address - Zip Code:65633-9107
Practice Address - Country:US
Practice Address - Phone:417-844-4252
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-30
Last Update Date:2010-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor