Provider Demographics
NPI:1750260055
Name:BRANAGAN, KIM STICHTER (OTR/L)
Entity type:Individual
Prefix:
First Name:KIM
Middle Name:STICHTER
Last Name:BRANAGAN
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 1:3402 W BARCELONA ST
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33629-7008
Mailing Address - Country:US
Mailing Address - Phone:813-928-6614
Mailing Address - Fax:
Practice Address - Street 1:1411 N WEST SHORE BLVD
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33607-4515
Practice Address - Country:US
Practice Address - Phone:813-928-6614
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-29
Last Update Date:2025-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT11767225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist