Provider Demographics
NPI:1891035267
Name:BARKLEY-BRACKETT, MONIQUE ANITA (OTR)
Entity Type:Individual
Prefix:MS
First Name:MONIQUE
Middle Name:ANITA
Last Name:BARKLEY-BRACKETT
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1650 LYNDON FARM CT STE 300
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40223-5005
Mailing Address - Country:US
Mailing Address - Phone:951-335-9825
Mailing Address - Fax:951-666-5096
Practice Address - Street 1:30141 ANTELOPE RD STE A
Practice Address - Street 2:
Practice Address - City:MENIFEE
Practice Address - State:CA
Practice Address - Zip Code:92584-8066
Practice Address - Country:US
Practice Address - Phone:951-723-8100
Practice Address - Fax:951-723-8101
Is Sole Proprietor?:No
Enumeration Date:2013-02-22
Last Update Date:2023-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX111483225X00000X
CA21691225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist