MR. BRADFORD ANTHONY WALLACE JR. (NPI# 1609821636) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1609821636 |
| Entity Type | Individual |
| Full Name | MR. BRADFORD ANTHONY WALLACE JR. |
| Practice Address |
130 Executive Dr Newark DE 19702-3349 |
| Mailing Address |
2327 Pennsylvania Ave Wilmington DE 19806-1318 |
| Practice Telephone | 3022923454 |
| Practice Fax Number | 3022923464 |
| Mailing Telephone | 3025719567 |
| Enumeration Date | 2006-05-25 |
| Last Update Date | 2007-07-08 |
| Gender Code | M |
| Is Sole Proprietor | X |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 224Z00000X | Occupational Therapy Assistant | J2-0000629 | DE | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| Street Address |
130 EXECUTIVE DR |
| City | NEWARK |
| State | DE |
| Zip Code | 19702-3349 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1295781243 | Jamie Shannon Soutar | Physical Therapy Assistant | 130 Executive Dr, Newark, DE 19702-3349 | 2006-05-25 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1407467814 | Leilanie Redondiez | Physical Therapist | 110 Blue Ridge Circle, Newark, DE 19702 | 2020-08-11 |
| 1285118679 | A Center for Mental Wellness Community Support Programs, LLC | Substance Abuse Rehabilitation Facility | 25 S. Old Baltimore Pike, Lafayette Building 1, Suite 201, Newark, DE 19702 | 2018-09-20 |
| 1124510854 | Shena Williams | Counselor | 1423 Capital Trail Rd, Newark, DE 19702 | 2018-05-30 |
| 1437664737 | Excellence Home Care LLC | Home Health | 122 Delaware Street, New Castle, DE 19702 | 2017-12-08 |
| 1710496773 | Kirt Leigh Randolph | Physical Therapy Assistant | 229 Barrett Run Place, Newark, DE 19702 | 2017-09-21 |
| 1871014399 | Edeline Elicin | Marriage & Family Therapist | 260 Chapman Road, Suite 100-b, Newark, DE 19702 | 2017-07-06 |
| 1831646454 | Rickia Izetta Spivey-kennedy | Counselor | 36 Avignon Drive, Newark, DE 19702 | 2016-09-01 |
| 1134585748 | Thomas Wolters | Pharmacist | 248 Chaoman Road, Newark, DE 19702 | 2016-01-12 |
| 1851700686 | Candice Roberts | Nurse Practitioner | 100 Biddle Ave Ste 101, Newark, DE 19702 | 2014-08-06 |
| 1316367428 | Evyline Chioma | Occupational Therapist | 25 Buttonwood Ct., Newark, DELAWARE 19702 | 2014-04-16 |
| Find all providers in zip 19702 | ||||
| Taxonomy Code | 224Z00000X |
| Grouping | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| Classification | Occupational Therapy Assistant |
| An occupational therapy assistant is a person who has graduated from an occupational therapy assistant program accredited by the Accreditation Council for Occupational Therapy Education (ACOTE) or predecessor organizations, has successfully completed a period of supervised fieldwork experience required by the accredited occupational therapy assistant program, has passed a nationally recognized entry-level examination for occupational therapy assistants, and fulfills state requirements for licensure, certification, or registration. An occupational therapy assistant provides interventions under the supervision of an occupational therapist which emphasize the therapeutic use of everyday life activities (i.e., occupations) with individuals or groups for the purpose of facilitating participation in roles and situations and in home, school, workplace, community and other settings. Occupational therapy services are provided for the purpose of promoting health and wellness and are provided to those who have or are at risk for developing an illness, injury, disease, disorder, condition, impairment, disability, activity limitation, or participation restriction. Occupational therapy assistants address the physical, cognitive, psychosocial, sensory, and other aspects of occupational performance in a variety of contexts to support engagement in everyday life activities that affect health, well-being, and quality of life. |
| Notes: Source: The Guide to Occupational Therapy Practice, 2nd edition. Bethesda: American Occupational Therapy Association, 2007. [7/1/2008: definition changed, source changed] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1013527894 | Millie S Mogouong | Occupational Therapy Assistant | 28 Richards St Apt 3, Newark, NJ 07105-3705 | 2020-08-05 |
| 1790321990 | Keisha Samuel | Occupational Therapy Assistant | 776 S 18th St Fl 2, Newark, NJ 07103-1050 | 2019-11-22 |
| 1942841614 | Crouch Therapy Services LLC | Occupational Therapy Assistant | 240 Dalton Ln, Newark, AR 72562-9400 | 2019-10-03 |
| 1235781139 | Ejiroghene R Okieruovo | Occupational Therapy Assistant | 123 Spruce St Apt 2b, Newark, NJ 07108-3088 | 2019-07-10 |
| 1992246664 | Elvira Njume | Occupational Therapy Assistant | 179 Keer Ave, Newark, NJ 07112-1709 | 2017-03-15 |
| 1396118980 | Elizabeth Hollett | Occupational Therapy Assistant | 44 W Kyla Marie Dr, Newark, DE 19702-5431 | 2015-11-05 |
| 1881075422 | Annette Maley | Occupational Therapy Assistant | 15 Bender Dr, Newark, DE 19711-3807 | 2015-06-09 |
| 1528474285 | Kisha Manley | Occupational Therapy Assistant | 68 Summer Ave, Newark, NJ 07104-2512 | 2014-07-02 |
| 1821412404 | Tracie Copley | Occupational Therapy Assistant | 11117 Lambs Ln, Newark, OH 43055-9779 | 2014-02-18 |
| 1871853309 | Sandy Lindsay Trinidad | Occupational Therapy Assistant | 366-368 14 Ave, Newark, NJ 07103 | 2012-05-17 |
| Find all providers in NEWARK | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.