Provider Demographics
NPI:1902648140
Name:BRATT, JACQUELINE CAROLE
Entity type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:CAROLE
Last Name:BRATT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7755 OFFICE PLAZA DR N STE 105
Mailing Address - Street 2:
Mailing Address - City:WEST DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50266-2339
Mailing Address - Country:US
Mailing Address - Phone:515-505-7283
Mailing Address - Fax:
Practice Address - Street 1:7755 OFFICE PLAZA DR N STE 105
Practice Address - Street 2:
Practice Address - City:WEST DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50266-2339
Practice Address - Country:US
Practice Address - Phone:515-505-7283
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-10
Last Update Date:2024-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA126486225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist