Healthcare Provider Details

I. General information

NPI: 1902138092
Provider Name (Legal Business Name): EMILY BRACKENRIDGE MS, OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/01/2010
Last Update Date: 11/16/2021
Certification Date: 11/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

321 W BEN WHITE BLVD STE 101
AUSTIN TX
78704-7086
US

IV. Provider business mailing address

1033 LA POSADA DR STE 230
AUSTIN TX
78752-3842
US

V. Phone/Fax

Practice location:
  • Phone: 512-215-9272
  • Fax: 512-215-8934
Mailing address:
  • Phone: 512-284-7192
  • Fax: 512-284-7203

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number115404
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: