Provider Demographics
NPI:1467719153
Name:BRACKETT, MICHELLE R (COTA)
Entity type:Individual
Prefix:MS
First Name:MICHELLE
Middle Name:R
Last Name:BRACKETT
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4436 COLLEEN CV
Mailing Address - Street 2:
Mailing Address - City:NICEVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32578-2467
Mailing Address - Country:US
Mailing Address - Phone:757-270-0227
Mailing Address - Fax:
Practice Address - Street 1:4436 COLLEEN CV
Practice Address - Street 2:
Practice Address - City:NICEVILLE
Practice Address - State:FL
Practice Address - Zip Code:32578-2467
Practice Address - Country:US
Practice Address - Phone:757-270-0227
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-18
Last Update Date:2025-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL16181224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant