Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0200X | Occupational Therapist - Pediatrics | 2385 | NH |
NPI | 1063821387 |
---|---|
Provider Name | Christina Brackett |
First Address | Stratham, NH 03885-2121 |
Second Address | Stratham, NH 03885-2121 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/08/2014 |
Last Update Date | 12/08/2014 |