Provider Demographics
NPI:1871215475
Name:BRACY, DENNIS (COTA)
Entity type:Individual
Prefix:
First Name:DENNIS
Middle Name:
Last Name:BRACY
Suffix:
Gender:M
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:117 PINE TOWERS CIR
Mailing Address - Street 2:
Mailing Address - City:SWANSEA
Mailing Address - State:SC
Mailing Address - Zip Code:29160-9073
Mailing Address - Country:US
Mailing Address - Phone:803-391-2596
Mailing Address - Fax:
Practice Address - Street 1:117 PINE TOWERS CIR
Practice Address - Street 2:
Practice Address - City:SWANSEA
Practice Address - State:SC
Practice Address - Zip Code:29160-9073
Practice Address - Country:US
Practice Address - Phone:803-391-2596
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-12
Last Update Date:2022-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC4849224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant