Provider Demographics
NPI:1497487268
Name:BRANNIGAN, KATHLEEN SMITH (OT/L)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:SMITH
Last Name:BRANNIGAN
Suffix:
Gender:F
Credentials:OT/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1019 BROOMSEDGE TER
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28412-1054
Mailing Address - Country:US
Mailing Address - Phone:336-207-4410
Mailing Address - Fax:
Practice Address - Street 1:1019 BROOMSEDGE TER
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28412-1054
Practice Address - Country:US
Practice Address - Phone:336-207-4410
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-29
Last Update Date:2022-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2052225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty