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NPI Code Detail

MEDICARE: MRS. LATISHA BRADLEY

MEDICARE: MRS. LATISHA BRADLEY
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1106E00000XAssistant Behavior Analyst

General Provider Information

NPI Number : 1093466880
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. LATISHA BRADLEY
Provider Business Mailing Address
First Line : 7108 S KANNER HWY
Second Line :
City : STUART
State : FL
Zip : 34997-7462
Country : US
Telephone Number : 855-832-6727
Fax Number :
Provider Business Practice Location Address
First Line : 1950 ELDRIDGE PKWY
Second Line :
City : HOUSTON
State : TX
Zip : 77077-3448
Country : US
Telephone Number : 855-832-6727
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/12/2022
Last Update Date : 01/12/2022

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Directions to “ MRS. LATISHA BRADLEY ” Practice Location

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