Healthcare Provider Details

I. General information

NPI: 1245541861
Provider Name (Legal Business Name): BRAD CHARLES ANDERSON OTR/L
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/29/2010
Last Update Date: 06/29/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1296 N CHESTER AVE
PASADENA CA
91104-2947
US

IV. Provider business mailing address

1443 E WASHINGTON BLVD NO. 806
PASADENA CA
91104-2650
US

V. Phone/Fax

Practice location:
  • Phone: 626-676-6558
  • Fax: 626-389-8748
Mailing address:
  • Phone: 626-676-6558
  • Fax: 626-389-8748

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225XE1200X
TaxonomyErgonomics Occupational Therapist
License NumberOT 4438
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code225XN1300X
TaxonomyNeurorehabilitation Occupational Therapist
License NumberOT 4438
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License NumberOT 4438
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code225XP0019X
TaxonomyPhysical Rehabilitation Occupational Therapist
License NumberOT 4438
License Number StateCA
# 5
Primary TaxonomyN
Taxonomy Code225XE0001X
TaxonomyEnvironmental Modification Occupational Therapist
License NumberOT 4438
License Number StateCA
# 6
Primary TaxonomyN
Taxonomy Code225XL0004X
TaxonomyLow Vision Occupational Therapist
License NumberOT 4438
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: