Provider Demographics
NPI:1962040493
Name:BRADLEY-BUNN, PATRICIA (COTA/L)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:
Last Name:BRADLEY-BUNN
Suffix:
Gender:F
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 1:7311 COAL CREEK PKWY SE APT K201
Mailing Address - Street 2:
Mailing Address - City:NEWCASTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98059-3068
Mailing Address - Country:US
Mailing Address - Phone:425-215-5568
Mailing Address - Fax:
Practice Address - Street 1:7311 COAL CREEK PKWY SE APT K201
Practice Address - Street 2:
Practice Address - City:NEWCASTLE
Practice Address - State:WA
Practice Address - Zip Code:98059-3068
Practice Address - Country:US
Practice Address - Phone:425-215-5568
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-16
Last Update Date:2019-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60989645224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy AssistantGroup - Single Specialty