Provider Demographics
NPI:1801399530
Name:STEMPKY, BRADLEY MARK (OTR/L)
Entity Type:Individual
Prefix:
First Name:BRADLEY
Middle Name:MARK
Last Name:STEMPKY
Suffix:
Gender:M
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 1:4060 VALLEY VISTA DR APT 104
Mailing Address - Street 2:
Mailing Address - City:HUDSONVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:49426-7969
Mailing Address - Country:US
Mailing Address - Phone:231-420-3584
Mailing Address - Fax:
Practice Address - Street 1:2 N SAINT JOSEPH AVE
Practice Address - Street 2:
Practice Address - City:NILES
Practice Address - State:MI
Practice Address - Zip Code:49120-2214
Practice Address - Country:US
Practice Address - Phone:269-687-1419
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-08
Last Update Date:2018-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5201009998225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist