Provider Demographics
NPI:1174259725
Name:BRADLEY, FAITH VICTORIA
Entity Type:Individual
Prefix:
First Name:FAITH
Middle Name:VICTORIA
Last Name:BRADLEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1891 FAIRFIELD DR
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:27215-6578
Mailing Address - Country:US
Mailing Address - Phone:336-266-2631
Mailing Address - Fax:
Practice Address - Street 1:601 MARTIN LUTHER KING JR. DR.
Practice Address - Street 2:432 FL ATKINS BLDG
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27110
Practice Address - Country:US
Practice Address - Phone:336-266-2631
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-26
Last Update Date:2022-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist