Provider Demographics
NPI:1871922427
Name:BRAGG, STACEY (OTR/L)
Entity type:Individual
Prefix:MRS
First Name:STACEY
Middle Name:
Last Name:BRAGG
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2202 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:NE
Mailing Address - Zip Code:68005-5257
Mailing Address - Country:US
Mailing Address - Phone:402-898-1050
Mailing Address - Fax:
Practice Address - Street 1:2202 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:NE
Practice Address - Zip Code:68005-5257
Practice Address - Country:US
Practice Address - Phone:402-898-1050
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-11-04
Last Update Date:2013-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE695225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist