Provider Demographics
NPI:1205060506
Name:BRADLEY, SUSAN LEIGH (CERTIFIED THERAPEUTI)
Entity type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:LEIGH
Last Name:BRADLEY
Suffix:
Gender:F
Credentials:CERTIFIED THERAPEUTI
Other - Prefix:MISS
Other - First Name:SUSAN
Other - Middle Name:LEIGH
Other - Last Name:ADAIR
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CERTIFIED THERAPEUTI
Mailing Address - Street 1:2200 FORT ROOTS DR
Mailing Address - Street 2:
Mailing Address - City:NORTH LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72114-1709
Mailing Address - Country:US
Mailing Address - Phone:501-257-3469
Mailing Address - Fax:501-257-2253
Practice Address - Street 1:2200 FORT ROOTS DRIVE
Practice Address - Street 2:
Practice Address - City:NORTH LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72114-1706
Practice Address - Country:US
Practice Address - Phone:501-257-3469
Practice Address - Fax:501-257-2253
Is Sole Proprietor?:No
Enumeration Date:2009-05-14
Last Update Date:2009-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYID#22745225800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225800000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRecreation Therapist