Provider Demographics
NPI:1063617793
Name:BRADSHAW, DARLA JEAN (OTR)
Entity type:Individual
Prefix:MS
First Name:DARLA
Middle Name:JEAN
Last Name:BRADSHAW
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4948 COUNTY ROAD 1200
Mailing Address - Street 2:
Mailing Address - City:CLEBURNE
Mailing Address - State:TX
Mailing Address - Zip Code:76031-0837
Mailing Address - Country:US
Mailing Address - Phone:817-641-8833
Mailing Address - Fax:
Practice Address - Street 1:1108 W KILPATRICK ST
Practice Address - Street 2:
Practice Address - City:CLEBURNE
Practice Address - State:TX
Practice Address - Zip Code:76033-7477
Practice Address - Country:US
Practice Address - Phone:817-202-9520
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX109834225X00000X, 225XH1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Not Answered225XH1300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHuman Factors