Individual
TARA BRADLEY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MA, OTR/L
Contact information
Practice address
30412 ESPERANZA, RANCHO SANTA MARGARITA, CA 92688
(949) 459-1658
Mailing address
15 GRACE LANE, COTO DE CAZA, CA 92679
(949) 212-4221
Taxonomy
Speciality
Code
Description
License number
State
225XP0200X
Pediatric Occupational Therapist
Primary
OT 10033
CA
Other
Enumeration date
10/15/2010
Last updated
10/15/2010
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