Healthcare Provider Details

I. General information

NPI: 1083212583
Provider Name (Legal Business Name): MORCIA K BRADLEY CERTIFIED HAIR LOSS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/16/2020
Last Update Date: 09/08/2025
Certification Date: 09/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9367 TWO NOTCH RD STE 118
COLUMBIA SC
29223-6442
US

IV. Provider business mailing address

10120 TWO NOTCH RD # 157
COLUMBIA SC
29223-4395
US

V. Phone/Fax

Practice location:
  • Phone: 803-801-1003
  • Fax:
Mailing address:
  • Phone: 907-350-1003
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1744P3200X
TaxonomyProsthetics Case Management
License Number74614
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: