MEDICARE: TANIKA 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
1	3747A0650X	Attendant Care Provider
2	3747P1801X	Personal Care Attendant

General Provider Information

NPI Number	:	1982477261
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TANIKA BRADLEY

Provider Business Mailing Address
First Line	:	501 W BUTLER RD STE G
Second Line	:
City	:	GREENVILLE
State	:	SC
Zip	:	29607-4846
Country	:	US
Telephone Number	:	864-520-1131
Fax Number	:	864-520-2277

Provider Business Practice Location Address
First Line	:	501 W BUTLER RD STE G
Second Line	:
City	:	GREENVILLE
State	:	SC
Zip	:	29607-4846
Country	:	US
Telephone Number	:	864-520-1131
Fax Number	:	864-520-2277

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

Provider Enumeration Date	:	10/30/2023
Last Update Date	:	10/30/2023

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Directions to “ TANIKA BRADLEY ” Practice Location

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