Provider Demographics
NPI:1083212583
Name:BRADLEY, MORCIA K (CERTIFIED HAIR LOSS)
Entity Type:Individual
Prefix:
First Name:MORCIA
Middle Name:K
Last Name:BRADLEY
Suffix:
Gender:F
Credentials:CERTIFIED HAIR LOSS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10120 TWO NOTCH RD # 157
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29223-4395
Mailing Address - Country:US
Mailing Address - Phone:907-350-1003
Mailing Address - Fax:
Practice Address - Street 1:6800 SHAKESPEARE RD STE D
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29223-7512
Practice Address - Country:US
Practice Address - Phone:907-350-1003
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-16
Last Update Date:2020-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC746141744P3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1744P3200XOther Service ProvidersSpecialistProsthetics Case Management