Provider Demographics
NPI:1346438231
Name:BRADLEY, MICHAEL E (OTR/L)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:E
Last Name:BRADLEY
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 1:4179 WOODLEY CREEK RD
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32218-9185
Mailing Address - Country:US
Mailing Address - Phone:904-764-8549
Mailing Address - Fax:
Practice Address - Street 1:4179 WOODLEY CREEK RD
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32218-9185
Practice Address - Country:US
Practice Address - Phone:904-764-8549
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-10-04
Last Update Date:2016-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT16015225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist