Provider Demographics
NPI:1952518326
Name:BRACKIN, KIRK A (OTR)
Entity Type:Individual
Prefix:MR
First Name:KIRK
Middle Name:A
Last Name:BRACKIN
Suffix:
Gender:M
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7770 DEER TRAIL PL
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75238-4113
Mailing Address - Country:US
Mailing Address - Phone:214-543-8100
Mailing Address - Fax:
Practice Address - Street 1:9330 POPPY DR
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75218-4621
Practice Address - Country:US
Practice Address - Phone:214-324-6000
Practice Address - Fax:214-904-6576
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-16
Last Update Date:2014-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX110505225X00000X, 225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist