Individual
JESSICA L BRADFORD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ORTL
Contact information
Practice address
505 KELLER AVE SQ, AMERY, WI 54001
(715) 268-6900
(715) 268-6895
Mailing address
505 KELLER AVE SQ, AMERY, WI 54001
(715) 268-6900
(715) 268-6895
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
4452 026
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
41037300
—
WI
01
—
530COBR
BC BS OF MN
—
01
—
6406747
MEDICA INS
—
01
—
HP66372
HEALTH PARTNERS
—
Enumeration date
12/05/2006
Last updated
07/08/2007
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