Provider Demographics
NPI:1427729060
Name:HEBDEN, BRADFORD WYMAN (OTR)
Entity type:Individual
Prefix:
First Name:BRADFORD
Middle Name:WYMAN
Last Name:HEBDEN
Suffix:
Gender:M
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:36948 FOX RUN
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48331-1812
Mailing Address - Country:US
Mailing Address - Phone:248-302-1878
Mailing Address - Fax:
Practice Address - Street 1:21017 MIDDLEBELT RD
Practice Address - Street 2:
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48336-5547
Practice Address - Country:US
Practice Address - Phone:248-476-8330
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-23
Last Update Date:2022-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT22347225X00000X
MI5201011118225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist