Provider Demographics
NPI:1700107356
Name:BRADLEY, JACQUELIN ELIZABETH (OTR/L)
Entity type:Individual
Prefix:MRS
First Name:JACQUELIN
Middle Name:ELIZABETH
Last Name:BRADLEY
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12580 PALO ALTO LN SE
Mailing Address - Street 2:
Mailing Address - City:PORT ORCHARD
Mailing Address - State:WA
Mailing Address - Zip Code:98367-9475
Mailing Address - Country:US
Mailing Address - Phone:360-876-0607
Mailing Address - Fax:
Practice Address - Street 1:3517 11TH ST
Practice Address - Street 2:
Practice Address - City:BREMERTON
Practice Address - State:WA
Practice Address - Zip Code:98312-2633
Practice Address - Country:US
Practice Address - Phone:360-377-5537
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-17
Last Update Date:2010-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOT 00001563225XG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XG0600XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGerontology