Provider Demographics
NPI:1285831966
Name:BRADLEY, KRISTIN NEELY (OTR)
Entity type:Individual
Prefix:MRS
First Name:KRISTIN
Middle Name:NEELY
Last Name:BRADLEY
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 1:4376 STONE MOUNTAIN DR
Mailing Address - Street 2:
Mailing Address - City:GASTONIA
Mailing Address - State:NC
Mailing Address - Zip Code:28054-0007
Mailing Address - Country:US
Mailing Address - Phone:704-824-1791
Mailing Address - Fax:
Practice Address - Street 1:716 SIPES ST
Practice Address - Street 2:
Practice Address - City:KINGS MOUNTAIN
Practice Address - State:NC
Practice Address - Zip Code:28086-2716
Practice Address - Country:US
Practice Address - Phone:704-739-8132
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5067225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist