Individual
MICHELLE JENE BRADSHAW
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
OT002590
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
10035964
AMERIGROUP
GA
01
—
312667
WELLCARE
GA
01
—
52171843 001
BLUE CROSS BLUE SHIELD
GA
01
—
52171843 002
BLUE CROSS BLUE SHIELD
GA
01
—
52171843 003
BLUE CROSS BLUE SHIELD
GA
Enumeration date
11/14/2006
Last updated
07/08/2007
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