MEDICARE: JENNIFER VICTORIA BRADLEY MS O.T.

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
1	225XP0200X	Pediatric Occupational Therapist		AZ

General Provider Information

NPI Number	:	1174854327
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER VICTORIA BRADLEY MS O.T.

Provider Business Mailing Address
First Line	:	9340 E REDFIELD RD UNIT 2019
Second Line	:
City	:	SCOTTSDALE
State	:	AZ
Zip	:	85260-3783
Country	:	US
Telephone Number	:	602-799-1780
Fax Number	:

Provider Business Practice Location Address
First Line	:	4600 E SHEA BLVD STE 101
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85028-6031
Country	:	US
Telephone Number	:	602-368-8601
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/27/2010
Last Update Date	:	01/27/2010

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