Provider Demographics
NPI:1932730009
Name:BRADLEY, CHELSEA S (TL61029859)
Entity Type:Individual
Prefix:
First Name:CHELSEA
Middle Name:S
Last Name:BRADLEY
Suffix:
Gender:F
Credentials:TL61029859
Other - Prefix:
Other - First Name:CHELSEA
Other - Middle Name:S
Other - Last Name:KELLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2346 N 178TH ST
Mailing Address - Street 2:
Mailing Address - City:SHORELINE
Mailing Address - State:WA
Mailing Address - Zip Code:98133-5148
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1981 NE COLUMBIA ROAD
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:91895-7925
Practice Address - Country:US
Practice Address - Phone:206-543-4011
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-28
Last Update Date:2020-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WATL61029859225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist