Provider Demographics
NPI:1669795597
Name:BRADLEY, LEONORA THERESA (MS, OTR, CIMI)
Entity type:Individual
Prefix:MRS
First Name:LEONORA
Middle Name:THERESA
Last Name:BRADLEY
Suffix:
Gender:F
Credentials:MS, OTR, CIMI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:928 ARNOLD AVE
Mailing Address - Street 2:SUITE E
Mailing Address - City:POINT PLEASANT BORO
Mailing Address - State:NJ
Mailing Address - Zip Code:08742-2368
Mailing Address - Country:US
Mailing Address - Phone:732-899-8050
Mailing Address - Fax:732-612-1354
Practice Address - Street 1:928 ARNOLD AVE
Practice Address - Street 2:SUITE E
Practice Address - City:POINT PLEASANT BORO
Practice Address - State:NJ
Practice Address - Zip Code:08742-2368
Practice Address - Country:US
Practice Address - Phone:732-899-8050
Practice Address - Fax:732-612-1354
Is Sole Proprietor?:No
Enumeration Date:2010-03-06
Last Update Date:2010-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ46TR00282500225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist