Healthcare Provider Details

I. General information

NPI: 1083528459
Provider Name (Legal Business Name): KATHERINE LONNA BRADSHAW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/01/2026
Last Update Date: 10/01/2026
Certification Date: 10/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 N SCOVEL ST
TEMPE AZ
85288-1698
US

IV. Provider business mailing address

4814 N GRANITE REEF RD
SCOTTSDALE AZ
85251-1725
US

V. Phone/Fax

Practice location:
  • Phone: 480-941-2440
  • Fax:
Mailing address:
  • Phone: 480-229-8662
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: