Provider Demographics
NPI:1518126127
Name:BRACKEN, AMY KATHLEEN (OT)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:KATHLEEN
Last Name:BRACKEN
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1101 JEFFERSON ST
Mailing Address - Street 2:
Mailing Address - City:HENDERSONVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28739-4121
Mailing Address - Country:US
Mailing Address - Phone:828-337-3553
Mailing Address - Fax:
Practice Address - Street 1:1101 JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:HENDERSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28739-4121
Practice Address - Country:US
Practice Address - Phone:828-337-3553
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-09
Last Update Date:2011-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC6869225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics