Provider Demographics
NPI:1497960363
Name:BRUEGGEN, ACACIA D (OTR)
Entity Type:Individual
Prefix:
First Name:ACACIA
Middle Name:D
Last Name:BRUEGGEN
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:ACACIA
Other - Middle Name:D
Other - Last Name:WILLIAMSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR
Mailing Address - Street 1:27281 HIGHLAND DR
Mailing Address - Street 2:
Mailing Address - City:LOUISBURG
Mailing Address - State:KS
Mailing Address - Zip Code:66053-5302
Mailing Address - Country:US
Mailing Address - Phone:913-837-8413
Mailing Address - Fax:913-837-8413
Practice Address - Street 1:27281 HIGHLAND DR
Practice Address - Street 2:
Practice Address - City:LOUISBURG
Practice Address - State:KS
Practice Address - Zip Code:66053-5302
Practice Address - Country:US
Practice Address - Phone:913-837-8413
Practice Address - Fax:913-837-8413
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1701329225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist