Provider Demographics
NPI:1053596759
Name:BRAGERS, MARY PATRICIA (OTR)
Entity type:Individual
Prefix:MRS
First Name:MARY
Middle Name:PATRICIA
Last Name:BRAGERS
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:MRS
Other - First Name:MARY PAT
Other - Middle Name:
Other - Last Name:BRAGERS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:OTR
Mailing Address - Street 1:4011 W PLANO PKWY
Mailing Address - Street 2:SUITE 118
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75093-5629
Mailing Address - Country:US
Mailing Address - Phone:972-596-6192
Mailing Address - Fax:
Practice Address - Street 1:4011 W PLANO PKWY
Practice Address - Street 2:SUITE 118
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093-5629
Practice Address - Country:US
Practice Address - Phone:972-596-6192
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-01-02
Last Update Date:2008-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX003085174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist