Individual
LACEY RAE BRADFORD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MOTR/L
Contact information
Practice address
5001 CONVICT HILL RD, APT 1106, AUSTIN, TX 78749-2272
(541) 206-4467
Mailing address
5001 CONVICT HILL RD, APT 1106, AUSTIN, TX 78749-2272
(541) 206-4467
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
113949
TX
225X00000X
Occupational Therapist
277138
OR
225XM0800X
Mental Health Occupational Therapist
—
—
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
10/23/2008
Last updated
06/15/2011
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