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General NPI Number Information
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NPI Number | 1205505856
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Entity Type | Individual
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Provider Name | CARLEY BRADSHAW
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Gender | Female
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Dates
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Enumeration Date | 09/08/2021
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Last Update Date | 01/15/2025
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Provider Practice Location Address
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Address Line | 17210 MIDLAND DR
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City | SHAWNEE
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State | KS
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Zip | 66217-8901
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Country | US
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Telephone | 913-777-9718
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Fax |
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Provider Business Mailing Address
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Address Line | 5400 ROCK CHALK DR APT 24101
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City | LAWRENCE
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State | KS
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Zip | 66049-5169
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Country | US
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Telephone | 913-306-5964
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number |
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License Number State | KS
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Taxonomy #2
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Taxonomy Code | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number |
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License Number State |
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