Most Relevant Information
Provider Data
| NPI Number: | 1003310459 |
| Provider Name: | CHARLENE BRADLEY |
| Entity Type: | Individual |
| Taxonomy Code: | 106S00000X |
| Specialty: | Behavior Technician |
| License Number: | 17-28108 |
Most Important Dates
| Enumeration Date: | 03/21/2018 |
| Last Updated: | 03/21/2018 |
Provider Practice Location
1345 COMPANION CT
SUMTER
SC
291501749
Practice Location Phone/Fax
| Phone: | 8039055107 |
| Fax: |
Provider Mailing Location
181 W PROFESSIONAL PARK CT STE 1
BOWLING GREEN
KY
421043250
Provider Mailing Phone/Fax
| Phone: | 2707779283 |
| Fax: | 2707779283 |