Provider Demographics
NPI:1063551679
Name:BRADSHER, DEBRA PASMORE (OTR)
Entity type:Individual
Prefix:MS
First Name:DEBRA
Middle Name:PASMORE
Last Name:BRADSHER
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:DEBRA
Other - Middle Name:PASMORE
Other - Last Name:HUBBARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR/L
Mailing Address - Street 1:466 COUNTY ROAD 1740
Mailing Address - Street 2:
Mailing Address - City:TUPELO
Mailing Address - State:MS
Mailing Address - Zip Code:38804-7129
Mailing Address - Country:US
Mailing Address - Phone:870-243-2695
Mailing Address - Fax:
Practice Address - Street 1:90 CLARK BLVD
Practice Address - Street 2:
Practice Address - City:TUPELO
Practice Address - State:MS
Practice Address - Zip Code:38804-2801
Practice Address - Country:US
Practice Address - Phone:662-840-0535
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-06
Last Update Date:2021-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AROTR1841225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5Y992OtherARKANSAS BLUE CROSS BLUE