Provider Demographics
NPI:1245541861
Name:ANDERSON, BRAD CHARLES (OTR/L)
Entity type:Individual
Prefix:MR
First Name:BRAD
Middle Name:CHARLES
Last Name:ANDERSON
Suffix:
Gender:M
Credentials:OTR/L
Other - Prefix:
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Mailing Address - Street 1:1443 E WASHINGTON BLVD
Mailing Address - Street 2:NO. 806
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91104-2650
Mailing Address - Country:US
Mailing Address - Phone:626-676-6558
Mailing Address - Fax:626-389-8748
Practice Address - Street 1:1296 N CHESTER AVE
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91104-2947
Practice Address - Country:US
Practice Address - Phone:626-676-6558
Practice Address - Fax:626-389-8748
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-29
Last Update Date:2010-06-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAOT 4438225XE0001X, 225XE1200X, 225XL0004X, 225XN1300X, 225XP0019X, 225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
No225XE0001XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistEnvironmental Modification
No225XE1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistErgonomics
No225XL0004XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistLow Vision
No225XN1300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistNeurorehabilitation
No225XP0019XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPhysical Rehabilitation