Individual
MR. JEROME W BRADIGAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
COTA/L
Contact information
Practice address
425 E MAIN ST, FREDONIA, NY 14063-1451
(716) 679-1581
(716) 679-9043
Mailing address
10 HOLMES PL, FREDONIA, NY 14063-1214
(716) 672-7723
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
005572-1
NY
Other
Enumeration date
09/16/2010
Last updated
09/16/2010
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