Provider Demographics
NPI:1114058302
Name:JONES, BRADLEY W (OTR L)
Entity Type:Individual
Prefix:
First Name:BRADLEY
Middle Name:W
Last Name:JONES
Suffix:
Gender:M
Credentials:OTR L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3000 DUNDEE RD
Mailing Address - Street 2:SUITE 418
Mailing Address - City:NORTHBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60062-2422
Mailing Address - Country:US
Mailing Address - Phone:847-480-7833
Mailing Address - Fax:
Practice Address - Street 1:3000 DUNDEE RD
Practice Address - Street 2:SUITE 418
Practice Address - City:NORTHBROOK
Practice Address - State:IL
Practice Address - Zip Code:60062-2422
Practice Address - Country:US
Practice Address - Phone:847-480-7833
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-08
Last Update Date:2012-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL056 003367225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL01633043OtherBC BS OF IL PROVIDER
IL01633043OtherBC BS OF IL PROVIDER