Provider Demographics
NPI:1407003452
Name:SOLORIO BRADLEY, KELLY ANN (OTR/L)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:ANN
Last Name:SOLORIO BRADLEY
Suffix:
Gender:F
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 1:430 W WILSHIRE BLVD
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73116-7771
Mailing Address - Country:US
Mailing Address - Phone:405-840-1686
Mailing Address - Fax:
Practice Address - Street 1:430 W WILSHIRE BLVD
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73116-7771
Practice Address - Country:US
Practice Address - Phone:405-840-1686
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-08-21
Last Update Date:2008-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1573225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics