Healthcare Provider Details

I. General information

NPI: 1891035267
Provider Name (Legal Business Name): MONIQUE ANITA BARKLEY-BRACKETT OTR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/22/2013
Last Update Date: 03/31/2023
Certification Date: 03/31/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30141 ANTELOPE RD STE A
MENIFEE CA
92584-8066
US

IV. Provider business mailing address

1650 LYNDON FARM CT STE 300
LOUISVILLE KY
40223-5005
US

V. Phone/Fax

Practice location:
  • Phone: 951-723-8100
  • Fax: 951-723-8101
Mailing address:
  • Phone: 951-335-9825
  • Fax: 951-666-5096

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number111483
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number21691
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: