Provider Demographics
NPI:1275019713
Name:BRADFIELD, VIKTORIA K (MS/OTR/L)
Entity Type:Individual
Prefix:
First Name:VIKTORIA
Middle Name:K
Last Name:BRADFIELD
Suffix:
Gender:F
Credentials:MS/OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6542 SUSSEX ST
Mailing Address - Street 2:
Mailing Address - City:PORTAGE
Mailing Address - State:MI
Mailing Address - Zip Code:49024-8921
Mailing Address - Country:US
Mailing Address - Phone:847-445-5694
Mailing Address - Fax:
Practice Address - Street 1:1200 ELY ST
Practice Address - Street 2:
Practice Address - City:ALLEGAN
Practice Address - State:MI
Practice Address - Zip Code:49010-9368
Practice Address - Country:US
Practice Address - Phone:269-673-1500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-18
Last Update Date:2018-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5201007627225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist