Individual
SHANE BRADLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OTA
Contact information
Practice address
1100 S COURTENAY PKWY, MERRITT ISLAND, FL 32952-3804
(321) 452-1233
Mailing address
8477 S SUNCOAST BLVD, HOMOSASSA, FL 34446-5028
(352) 382-7214
(352) 382-7781
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
OTA17590
FL
Other
Enumeration date
02/19/2020
Last updated
02/19/2020
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