Provider Demographics
NPI:1114134533
Name:BRADLEY, GREER VERSON (OT)
Entity Type:Individual
Prefix:MRS
First Name:GREER
Middle Name:VERSON
Last Name:BRADLEY
Suffix:
Gender:F
Credentials:OT
Other - Prefix:MS
Other - First Name:GREER
Other - Middle Name:VERSON
Other - Last Name:JACOBSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1529 CREEKSIDE DR
Mailing Address - Street 2:
Mailing Address - City:PETALUMA
Mailing Address - State:CA
Mailing Address - Zip Code:94954-3501
Mailing Address - Country:US
Mailing Address - Phone:707-849-9657
Mailing Address - Fax:
Practice Address - Street 1:1260 N DUTTON AVE STE 150
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95401-4680
Practice Address - Country:US
Practice Address - Phone:707-545-7114
Practice Address - Fax:707-253-1182
Is Sole Proprietor?:No
Enumeration Date:2007-05-16
Last Update Date:2022-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOT13448225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist