Provider Demographics
NPI:1710280474
Name:BRADFORD, SHELBY JOY (MSOTR/L)
Entity Type:Individual
Prefix:
First Name:SHELBY
Middle Name:JOY
Last Name:BRADFORD
Suffix:
Gender:F
Credentials:MSOTR/L
Other - Prefix:
Other - First Name:SHELBY
Other - Middle Name:JOY
Other - Last Name:PICKERING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:24 PAPERMILL RD
Mailing Address - Street 2:
Mailing Address - City:HAMPDEN
Mailing Address - State:ME
Mailing Address - Zip Code:04444-1500
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:129 HARTLAND RD
Practice Address - Street 2:
Practice Address - City:SAINT ALBANS
Practice Address - State:ME
Practice Address - Zip Code:04971-7308
Practice Address - Country:US
Practice Address - Phone:207-938-4581
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-12-17
Last Update Date:2010-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEOT2486225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist