Provider Demographics
NPI:1497920490
Name:BRACEWELL, MARGARET (OTR/L)
Entity Type:Individual
Prefix:
First Name:MARGARET
Middle Name:
Last Name:BRACEWELL
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:MARGARET
Other - Middle Name:
Other - Last Name:BRACEWELL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OTR/L
Mailing Address - Street 1:2301 WOODLAKE DR
Mailing Address - Street 2:
Mailing Address - City:UKIAH
Mailing Address - State:CA
Mailing Address - Zip Code:95482-3660
Mailing Address - Country:US
Mailing Address - Phone:707-463-3250
Mailing Address - Fax:707-468-5949
Practice Address - Street 1:2301 WOODLAKE DR
Practice Address - Street 2:
Practice Address - City:UKIAH
Practice Address - State:CA
Practice Address - Zip Code:95482-3660
Practice Address - Country:US
Practice Address - Phone:707-463-3250
Practice Address - Fax:707-468-5949
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-30
Last Update Date:2013-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOT5148174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAOT0051480OtherBLUE SHIELD