MEDICARE: KIM BRADLEE CPM

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	176B00000X	Midwife

General Provider Information

NPI Number	:	1770796682
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIM BRADLEE CPM

Provider Business Mailing Address
First Line	:	30 VALLEY VIEW FARM RD
Second Line	:
City	:	BRADFORD
State	:	MA
Zip	:	01835-7657
Country	:	US
Telephone Number	:	978-223-0650
Fax Number	:

Provider Business Practice Location Address
First Line	:	30 VALLEY VIEW FARM RD
Second Line	:
City	:	BRADFORD
State	:	MA
Zip	:	01835-7657
Country	:	US
Telephone Number	:	978-521-5270
Fax Number	:

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

Provider Enumeration Date	:	05/07/2007
Last Update Date	:	12/20/2021

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