Healthcare Provider Details

I. General information

NPI: 1639093511
Provider Name (Legal Business Name): JACQUELINE BRACHO OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/05/2026
Last Update Date: 08/05/2026
Certification Date: 08/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1900 COFFEE RD
MODESTO CA
95355-2703
US

IV. Provider business mailing address

2909 N 118TH ST STE 200
OMAHA NE
68164-3643
US

V. Phone/Fax

Practice location:
  • Phone: 209-526-1775
  • Fax:
Mailing address:
  • Phone: 402-509-5532
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOC021464
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: