Healthcare Provider Details

I. General information

NPI: 1952537722
Provider Name (Legal Business Name): NAKEIA BRADLEY ERVIN OTR/L, MHA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/06/2009
Last Update Date: 06/06/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

215 CHURCH ST
PHILADELPHIA PA
19106-4518
US

IV. Provider business mailing address

215 CHURCH ST
PHILADELPHIA PA
19106-4518
US

V. Phone/Fax

Practice location:
  • Phone: 800-974-6383
  • Fax: 800-974-4241
Mailing address:
  • Phone: 800-974-6383
  • Fax: 800-974-4241

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOC010750
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: