Provider Demographics
NPI:1861894479
Name:BRADLEY, GERALYN JOY (COTA/L)
Entity type:Individual
Prefix:MS
First Name:GERALYN
Middle Name:JOY
Last Name:BRADLEY
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:44 W 100 N
Mailing Address - Street 2:
Mailing Address - City:PIMA
Mailing Address - State:AZ
Mailing Address - Zip Code:85543-9669
Mailing Address - Country:US
Mailing Address - Phone:928-348-3888
Mailing Address - Fax:
Practice Address - Street 1:1600 S 20TH AVE
Practice Address - Street 2:
Practice Address - City:SAFFORD
Practice Address - State:AZ
Practice Address - Zip Code:85546-4011
Practice Address - Country:US
Practice Address - Phone:928-348-3888
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-25
Last Update Date:2014-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ5440224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant