Active NPI
Brandon Bracy, COTA/L
- Occupational Therapy Assistant
- Avondale, AZ
National Provider Identifier
1801427596
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapy Assistant
- License
- 5089
- Practice address
- 350 E la Canada Blvd
Avondale, AZ 85323-1643 - Phone
- (623) 932-2282
- NPI assigned
- Jan 31, 2020
- Last updated
- Jan 31, 2020
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Occupational Therapy Assistant | 224Z00000X | 5089 | AZ | Primary |
Addresses
Primary practice location
350 E la Canada Blvd
Avondale, AZ 85323-1643
Mailing address
19443 W Morning Glory Dr
Buckeye, AZ 85326-5810
Phone (330) 573-9566
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 5089 | AZ | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1580428800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1580428800000",
"number": "1801427596",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "19443 W MORNING GLORY DR",
"city": "BUCKEYE",
"state": "AZ",
"postal_code": "853265810",
"telephone_number": "330-573-9566"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "350 E LA CANADA BLVD",
"city": "AVONDALE",
"state": "AZ",
"postal_code": "853231643",
"telephone_number": "623-932-2282"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BRACY",
"first_name": "BRANDON",
"credential": "COTA/L",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2020-01-31",
"last_updated": "2020-01-31",
"certification_date": "2020-01-31",
"status": "A"
},
"taxonomies": [
{
"code": "224Z00000X",
"taxonomy_group": "",
"desc": "Occupational Therapy Assistant",
"state": "AZ",
"license": "5089",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Avondale, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 31, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.