Provider Demographics
NPI:1740960673
Name:BRADFORD, KELLI JO (PERSONAL CARE ATTEND)
Entity type:Individual
Prefix:
First Name:KELLI
Middle Name:JO
Last Name:BRADFORD
Suffix:
Gender:F
Credentials:PERSONAL CARE ATTEND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 42
Mailing Address - Street 2:
Mailing Address - City:BATAVIA
Mailing Address - State:OH
Mailing Address - Zip Code:45103-0042
Mailing Address - Country:US
Mailing Address - Phone:513-306-1602
Mailing Address - Fax:
Practice Address - Street 1:2890 CRANE SCHOOLHOUSE RD
Practice Address - Street 2:
Practice Address - City:BETHEL
Practice Address - State:OH
Practice Address - Zip Code:45106-9453
Practice Address - Country:US
Practice Address - Phone:513-306-1602
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-25
Last Update Date:2024-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant