Individual
BRADLEY EARL DAVIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MS, OTR/L
Contact information
Practice address
630 KENMOOR AVE SE, GRAND RAPIDS, MI 49546-8626
(517) 266-1700
Mailing address
1819 CRYSTAL LN, ALLEGAN, MI 49010-8534
(616) 970-1515
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
5201007761
MI
Other
Enumeration date
12/17/2018
Last updated
12/17/2018
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