Healthcare Provider Details

I. General information

NPI: 1922925452
Provider Name (Legal Business Name): RAVETTE NICHOL BRADFORD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/06/2026
Last Update Date: 07/06/2026
Certification Date: 07/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

269 LAZY BROOK DR
CHAPIN SC
29036-8240
US

IV. Provider business mailing address

269 LAZY BROOK DR
CHAPIN SC
29036-8240
US

V. Phone/Fax

Practice location:
  • Phone: 585-851-3339
  • Fax: 585-851-3339
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: