MEDICARE: MINDA BRACKMAN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225X00000X	Occupational Therapist	869	TN

General Provider Information

NPI Number	:	1184031494
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MINDA BRACKMAN

Provider Business Mailing Address
First Line	:	1070 PEERY RD
Second Line	:
City	:	KINGSTON SPRINGS
State	:	TN
Zip	:	37082-8950
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1070 PEERY RD
Second Line	:
City	:	KINGSTON SPRINGS
State	:	TN
Zip	:	37082-8950
Country	:	US
Telephone Number	:	615-952-3280
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/18/2014
Last Update Date	:	07/18/2014

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Directions to “ MINDA BRACKMAN ” Practice Location

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