Provider Demographics
NPI:1659609956
Name:BRADBURY, KIMBERLY NOELLE (OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:NOELLE
Last Name:BRADBURY
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:158 STATE ST
Mailing Address - Street 2:
Mailing Address - City:MERIDEN
Mailing Address - State:CT
Mailing Address - Zip Code:06450-3202
Mailing Address - Country:US
Mailing Address - Phone:203-237-7835
Mailing Address - Fax:
Practice Address - Street 1:158 STATE ST
Practice Address - Street 2:
Practice Address - City:MERIDEN
Practice Address - State:CT
Practice Address - Zip Code:06450-3202
Practice Address - Country:US
Practice Address - Phone:203-237-7835
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-24
Last Update Date:2009-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT002241225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist