Provider Demographics
NPI:1780826206
Name:BRAGG, MICHELLE LYNN
Entity Type:Individual
Prefix:MS
First Name:MICHELLE
Middle Name:LYNN
Last Name:BRAGG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2301 LAKE DEBRA DR
Mailing Address - Street 2:APT 133
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32835-6641
Mailing Address - Country:US
Mailing Address - Phone:407-414-5080
Mailing Address - Fax:
Practice Address - Street 1:2301 LAKE DEBRA DR
Practice Address - Street 2:APT 133
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32835-6641
Practice Address - Country:US
Practice Address - Phone:407-414-5080
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-30
Last Update Date:2009-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist