IndividualActive
Bradford Wallace
NPI 1609821636 · Occupational Therapy Assistant · Newark, DE
Provider details
- NPI number
- 1609821636
- Entity type
- Individual
- Primary specialty
- Occupational Therapy AssistantRespiratory, Developmental, Rehabilitative and Restorative Service Providers
- Sex
- Male
- License
- J2-0000629 (DE)
Specialties & taxonomies
Respiratory, Developmental, Rehabilitative and Restorative Service Providers
Practice location
130 Executive Dr
Newark, DE 19702-3349
Phone: (302) 292-3454
Fax: (302) 292-3464
Approximate (ZIP-level) locationGet directions
Mailing address
2327 Pennsylvania Ave
Wilmington, DE 19806-1318
Registry dates
- Enumerated
- 2006-05-25
- Last updated
- 2007-07-08
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.