Kathleen Louise Bradley, P. T.
Individual provider Active NPI Licensed Psychiatric Technician · Lakeport, CA
NPI 1376690776 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1376690776
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Licensed Psychiatric Technician 167G00000X
- License
- PT 30664 (CA)
- Practice address
- 991 Parallel Dr
Lakeport, CA 95453 - Phone
- (707) 263-4338
- NPI assigned
- Jan 5, 2007
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PT 30664 | CA | MD | Licensed Psychiatric Technician |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Licensed Psychiatric Technician | 167G00000X | PT 30664 | CA | Yes |
Addresses
Primary practice location
991 Parallel Dr
Lakeport, CA 95453
Mailing address
P.O. Box 671
Cobb, CA 95426-0671
Phone (707) 928-6712
Other providers in Lakeport, CA
- Donovan C Bland
- Martyna Joanna Blissky
- Ellen Marie Boersma
- Ronald J Botelho
- Emmalena Ann Boyd
- Stephen Peter Bradley
- David L. Browning
- Mark Louis Buehnerkemper
- Carleene Janice Cady
- Liliana Caicedo
All providers in Lakeport, CA · Licensed Psychiatric Technician in California
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.