Provider Demographics
NPI:1568095305
Name:BRADLEY, BRIANNA MCKAYLA (COTA)
Entity Type:Individual
Prefix:
First Name:BRIANNA
Middle Name:MCKAYLA
Last Name:BRADLEY
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:544 TALL TREES LN # 544
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37209-5147
Mailing Address - Country:US
Mailing Address - Phone:662-872-9002
Mailing Address - Fax:
Practice Address - Street 1:544 TALL TREES LN # 544
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37209-5147
Practice Address - Country:US
Practice Address - Phone:662-872-9002
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-20
Last Update Date:2020-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN3334224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant