Provider Demographics
NPI:1376759480
Name:BOUBEL, BRADFORD L (OTR, CHT)
Entity Type:Individual
Prefix:
First Name:BRADFORD
Middle Name:L
Last Name:BOUBEL
Suffix:
Gender:M
Credentials:OTR, CHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1318 MAYBERRY CIR
Mailing Address - Street 2:
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77479-3837
Mailing Address - Country:US
Mailing Address - Phone:281-343-7104
Mailing Address - Fax:281-725-5898
Practice Address - Street 1:17510 WEST GRAND PARKWAY SOUTH
Practice Address - Street 2:100
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77479
Practice Address - Country:US
Practice Address - Phone:281-725-5895
Practice Address - Fax:281-725-5898
Is Sole Proprietor?:No
Enumeration Date:2007-05-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX000225225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand