MEDICARE: MICHELE LEE BRADLEY OTR

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225X00000X	Occupational Therapist	OT10894	FL

General Provider Information

NPI Number	:	1285780775
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHELE LEE BRADLEY OTR

Provider Business Mailing Address
First Line	:	11247 TOPAZ ST
Second Line	:
City	:	SPRING HILL
State	:	FL
Zip	:	34608-2166
Country	:	US
Telephone Number	:	352-650-9919
Fax Number	:

Provider Business Practice Location Address
First Line	:	3385 MARINER BLVD
Second Line	:
City	:	SPRING HILL
State	:	FL
Zip	:	34609-2461
Country	:	US
Telephone Number	:	352-683-8882
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/26/2007
Last Update Date	:	07/08/2007

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