MEDICARE: BRADLEY RAY HARPER OTR/L

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	225X00000X	Occupational Therapist	00907	IA

General Provider Information

NPI Number	:	1184697583
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRADLEY RAY HARPER OTR/L

Provider Business Mailing Address
First Line	:	5403 VICTORIA AVE
Second Line	:	SUITE 20
City	:	DAVENPORT
State	:	IA
Zip	:	52807-3925
Country	:	US
Telephone Number	:	563-327-0132
Fax Number	:	563-359-5642

Provider Business Practice Location Address
First Line	:	5403 VICTORIA AVE
Second Line	:	SUITE 20
City	:	DAVENPORT
State	:	IA
Zip	:	52807-3925
Country	:	US
Telephone Number	:	563-327-0132
Fax Number	:	563-359-5642

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

Provider Enumeration Date	:	02/08/2006
Last Update Date	:	07/08/2007

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