Provider Demographics
NPI:1629702386
Name:BRADFORD, JORDAN AMBER (OTD, OTR/L)
Entity type:Individual
Prefix:
First Name:JORDAN
Middle Name:AMBER
Last Name:BRADFORD
Suffix:
Gender:F
Credentials:OTD, OTR/L
Other - Prefix:
Other - First Name:JORDAN
Other - Middle Name:AMBER
Other - Last Name:O'DONNELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6201 GREENLEIGH AVE
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21220-2004
Mailing Address - Country:US
Mailing Address - Phone:410-933-6423
Mailing Address - Fax:
Practice Address - Street 1:10803 FALLS RD STE 2100
Practice Address - Street 2:
Practice Address - City:LUTHERVILLE
Practice Address - State:MD
Practice Address - Zip Code:21093-4562
Practice Address - Country:US
Practice Address - Phone:410-583-2665
Practice Address - Fax:410-367-3307
Is Sole Proprietor?:No
Enumeration Date:2022-07-10
Last Update Date:2025-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD09694225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL22907OtherFLORIDA OT LICENSE
469710OtherNBCOT CERTIFICATION NUMBER
MD09694OtherMARYLAND OT LICENSE