Provider Demographics
NPI:1447414412
Name:BRADBURN, AMANDA L
Entity Type:Individual
Prefix:MS
First Name:AMANDA
Middle Name:L
Last Name:BRADBURN
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 1:12259 CHISELED STONE DR
Mailing Address - Street 2:
Mailing Address - City:FISHERS
Mailing Address - State:IN
Mailing Address - Zip Code:46037-4290
Mailing Address - Country:US
Mailing Address - Phone:317-670-1087
Mailing Address - Fax:317-579-0894
Practice Address - Street 1:12259 CHISELED STONE DR
Practice Address - Street 2:
Practice Address - City:FISHERS
Practice Address - State:IN
Practice Address - Zip Code:46037-4290
Practice Address - Country:US
Practice Address - Phone:317-670-1087
Practice Address - Fax:317-579-0894
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-17
Last Update Date:2008-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist