Provider Demographics
NPI:1518167741
Name:BAUER, BRADLEY S (OT)
Entity Type:Individual
Prefix:MR
First Name:BRADLEY
Middle Name:S
Last Name:BAUER
Suffix:
Gender:M
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1125 GROVE ST
Mailing Address - Street 2:STE 120
Mailing Address - City:LOUDON
Mailing Address - State:TN
Mailing Address - Zip Code:37774-3251
Mailing Address - Country:US
Mailing Address - Phone:865-458-8080
Mailing Address - Fax:865-458-4111
Practice Address - Street 1:1125 GROVE ST
Practice Address - Street 2:STE 120
Practice Address - City:LOUDON
Practice Address - State:TN
Practice Address - Zip Code:37774-3251
Practice Address - Country:US
Practice Address - Phone:865-458-8080
Practice Address - Fax:865-458-4111
Is Sole Proprietor?:No
Enumeration Date:2007-07-25
Last Update Date:2007-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNOT0000002648225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist