Provider Demographics
NPI:1497918643
Name:BEAN BRADFORD, JENNIFER FAY (COTA/L)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:FAY
Last Name:BEAN BRADFORD
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:MISS
Other - First Name:JENNIFER
Other - Middle Name:FAY
Other - Last Name:BEAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:COTA/L
Mailing Address - Street 1:PO BOX 4
Mailing Address - Street 2:
Mailing Address - City:WINCHESTER
Mailing Address - State:TN
Mailing Address - Zip Code:37398-0004
Mailing Address - Country:US
Mailing Address - Phone:931-962-3225
Mailing Address - Fax:931-962-3103
Practice Address - Street 1:1397 S COLLEGE ST
Practice Address - Street 2:
Practice Address - City:WINCHESTER
Practice Address - State:TN
Practice Address - Zip Code:37398-2414
Practice Address - Country:US
Practice Address - Phone:931-962-3225
Practice Address - Fax:931-962-3103
Is Sole Proprietor?:No
Enumeration Date:2008-07-08
Last Update Date:2008-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNOTA0000001397224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant