Provider Demographics
NPI:1518252493
Name:YARBROUGH, BRADLEY (COTA/L)
Entity Type:Individual
Prefix:MR
First Name:BRADLEY
Middle Name:
Last Name:YARBROUGH
Suffix:
Gender:M
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 CLUB PINES DR
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27834-6724
Mailing Address - Country:US
Mailing Address - Phone:252-412-2483
Mailing Address - Fax:
Practice Address - Street 1:201 CLUB PINES DR
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27834-6724
Practice Address - Country:US
Practice Address - Phone:252-412-2483
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-18
Last Update Date:2011-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC6444224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant