Provider Demographics
NPI:1881113710
Name:BRAGG, JESSICA MARION (OTR/L)
Entity type:Individual
Prefix:MISS
First Name:JESSICA
Middle Name:MARION
Last Name:BRAGG
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2015 S NORMAN ST UNIT B
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98144-2941
Mailing Address - Country:US
Mailing Address - Phone:425-444-1716
Mailing Address - Fax:
Practice Address - Street 1:2015 S NORMAN ST UNIT B
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98144-2941
Practice Address - Country:US
Practice Address - Phone:206-324-8200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-12
Last Update Date:2017-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA00003458225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist