1497920490 NPI number — MARGARET BRACEWELL OTR/L

Table of content: MARGARET BRACEWELL OTR/L (NPI 1497920490)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1497920490 NPI number — MARGARET BRACEWELL OTR/L

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BRACEWELL
Provider First Name:
MARGARET
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
OTR/L
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BRACEWELL
Provider Other First Name:
MARGARET
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
OTR/L
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1497920490
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/13/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2301 WOODLAKE DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
UKIAH
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95482-3660
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
707-463-3250
Provider Business Mailing Address Fax Number:
707-468-5949

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2301 WOODLAKE DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
UKIAH
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95482-3660
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
707-463-3250
Provider Business Practice Location Address Fax Number:
707-468-5949
Provider Enumeration Date:
04/30/2008

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  OT5148 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: OT0051480 . This is a "BLUE SHIELD" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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