MEDICARE: AKIRA BRADSHAW

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	106S00000X	Behavior Technician

General Provider Information

NPI Number	:	1679425896
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AKIRA BRADSHAW

Provider Business Mailing Address
First Line	:	1625 BEAR CREEK LN UNIT D
Second Line	:
City	:	PETOSKEY
State	:	MI
Zip	:	49770-8378
Country	:	US
Telephone Number	:	810-339-5399
Fax Number	:

Provider Business Practice Location Address
First Line	:	910 SPRING ST STE 4
Second Line	:
City	:	PETOSKEY
State	:	MI
Zip	:	49770-2881
Country	:	US
Telephone Number	:	810-339-5399
Fax Number	:

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

Provider Enumeration Date	:	02/11/2026
Last Update Date	:	02/11/2026

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Directions to “ AKIRA BRADSHAW ” Practice Location

Language	Start Address	Practice Location

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