Provider Demographics
NPI:1588464507
Name:FOSTER, BRAD (OTR/L)
Entity type:Individual
Prefix:
First Name:BRAD
Middle Name:
Last Name:FOSTER
Suffix:
Gender:
Credentials:OTR/L
Other - Prefix:
Other - First Name:BRADLEY
Other - Middle Name:J
Other - Last Name:FOSTER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:5235 JAMES LN APT 1202
Mailing Address - Street 2:
Mailing Address - City:CRESTWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60418-4152
Mailing Address - Country:US
Mailing Address - Phone:815-302-5696
Mailing Address - Fax:
Practice Address - Street 1:6020 151ST ST
Practice Address - Street 2:
Practice Address - City:OAK FOREST
Practice Address - State:IL
Practice Address - Zip Code:60452-1841
Practice Address - Country:US
Practice Address - Phone:708-687-0900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-18
Last Update Date:2025-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL056.016458225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist