Active NPI
Jacqueline Snow Bradley, COTA
- Occupational Therapy Assistant
- Eastover, NC
National Provider Identifier
1649585498
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapy Assistant
- License
- 4772
- Practice address
- 3532 Dunn Rd
Eastover, NC 28312-8894 - Phone
- (910) 323-3223
- NPI assigned
- Aug 17, 2010
- Last updated
- Aug 17, 2010
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Occupational Therapy Assistant | 224Z00000X | 4772 | NC | Primary |
Addresses
Primary practice location
3532 Dunn Rd
Eastover, NC 28312-8894
Mailing address
606 McLamb Dr
Fayetteville, NC 28301-2428
Phone (190) 488-9878
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 4772 | NC | MD | Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1282003200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1282003200000",
"number": "1649585498",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "606 MCLAMB DR",
"city": "FAYETTEVILLE",
"state": "NC",
"postal_code": "283012428",
"telephone_number": "190-488-9878"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3532 DUNN RD",
"city": "EASTOVER",
"state": "NC",
"postal_code": "283128894",
"telephone_number": "910-323-3223"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BRADLEY",
"first_name": "JACQUELINE",
"middle_name": "SNOW",
"credential": "COTA",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2010-08-17",
"last_updated": "2010-08-17",
"status": "A"
},
"taxonomies": [
{
"code": "224Z00000X",
"taxonomy_group": "",
"desc": "Occupational Therapy Assistant",
"state": "NC",
"license": "4772",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Eastover, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 17, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.