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1609821636
BRADFORD ANTHONY WALLACE
NEWARK, DE
NPI
1609821636
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
No
Primary Taxonomy
224Z00000X Occupational Therapy Assistant
(Licence: DE J2-0000629)
Enumeration Date
2006-05-25
Last Update Date
2007-07-08
Business Address
Mr. BRADFORD ANTHONY WALLACE
130 EXECUTIVE DR
NEWARK, DE 19702-3349
Phone number: 302-292-3454
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Mailing Address
Mr. BRADFORD ANTHONY WALLACE
2327 PENNSYLVANIA AVE
WILMINGTON, DE 19806-1318
Phone number: 302-571-9567
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