Lauren Sisk Bradford, MSOTR/L
Individual provider Active NPI Occupational Therapist · Salem, CT
NPI 1619212941 · NPPES record last updated Jun 14, 2014
Key facts
- NPI
- 1619212941
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Occupational Therapist 225X00000X
- License
- 4259 (CT)
- Practice address
- 11 Centre St
Suite 7
Salem, CT 06420-3844 - Phone
- (860) 949-2561
- NPI assigned
- Nov 27, 2012
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in CT
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20141208001487 | CT | Practitioner - Occupational Therapist in Private Practice | 1759603418 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 4259 | CT | MD | Professional Counselor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Physiocare Physical Therapy and Sports Medicine, LLC | Occupational Therapist | Current |
Accepting new patients |
| Physiocare Physical Therapy and Sports Medicine, LLC | Occupational Therapist | Current |
Accepting new patients |
Locations
131 Boston Post Rd
East Lyme, CT 06333
Phone (860) 691-1044
11 Centre St
Ste 7
Salem, CT 06420
Phone (860) 949-2561
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Occupational Therapy Assistant | 224Z00000X | 001152 | CT | |
| Occupational Therapist | 225X00000X | 4259 | CT | Yes |
Addresses
Primary practice location
11 Centre St
Suite 7
Salem, CT 06420-3844
Mailing address
67 Oconnell Rd
Colchester, CT 06415-1727
Phone (860) 575-1567
Other providers in Salem, CT
- Nicole Elizabeth Aldridge
- Jennah Bakke
- John Howard Bradford
- Joshua Cappello
- Lindsay Cochefski
- Shannon Demi
- Natalie D Edwards
- Freedom Care One LLC
All providers in Salem, CT · Occupational Therapist in Connecticut
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 14, 2014. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.