Provider Demographics
NPI:1366540890
Name:BRADBURN, ANTHONY L (OTR/L)
Entity type:Individual
Prefix:
First Name:ANTHONY
Middle Name:L
Last Name:BRADBURN
Suffix:
Gender:M
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34 THYME WAY
Mailing Address - Street 2:
Mailing Address - City:GOFFSTOWN
Mailing Address - State:NH
Mailing Address - Zip Code:03045-2946
Mailing Address - Country:US
Mailing Address - Phone:603-867-2308
Mailing Address - Fax:
Practice Address - Street 1:34 THYME WAY
Practice Address - Street 2:
Practice Address - City:GOFFSTOWN
Practice Address - State:NH
Practice Address - Zip Code:03045-2946
Practice Address - Country:US
Practice Address - Phone:603-867-2308
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH1471225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist