Provider Demographics
NPI:1184880635
Name:ANDERSON, BRADLEY RICHARD (MS OTR/L)
Entity type:Individual
Prefix:
First Name:BRADLEY
Middle Name:RICHARD
Last Name:ANDERSON
Suffix:
Gender:M
Credentials:MS OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:609 ARBOR CT
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND VILLAGE
Mailing Address - State:TX
Mailing Address - Zip Code:75077-7569
Mailing Address - Country:US
Mailing Address - Phone:928-304-2223
Mailing Address - Fax:
Practice Address - Street 1:609 ARBOR CT
Practice Address - Street 2:
Practice Address - City:HIGHLAND VILLAGE
Practice Address - State:TX
Practice Address - Zip Code:75077-7569
Practice Address - Country:US
Practice Address - Phone:928-304-2223
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-04
Last Update Date:2014-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX115435225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist