Alexis Brackins

NPI1093482978

Summary

Provider Details

NPI Number 1093482978
Provider Name Alexis Brackins
Credential
Specialization
Medical School Name Other
Graduation Year 2021
Gender F
Entity Type Individual
PAC ID by PECOS 0648648014
Professional Enrollment ID I20221116002874
Enumeration Date 08/27/2021
Last Update Date 09/29/2021

Contact Details

Business Practice address 40124 HIGHWAY 27 STE 103, Davenport,
33837-5905 Florida View on Google Map
Business Practice phone 863-419-2500
Business Practice fax
Mailing address 130 TOWN CENTER BLVD APT 6107, Clermont,
34714-4448 Florida View on Google Map
Other phone
Other fax
Email Address shannonfig@domain.com Reval Email Address
Incorrect information? Update the NPI Details for Alexis Brackins Update NPI

Hospital Affilitation

Practices in Davenport

Davenport, Florida

Education & Training

Other

2021

Group Affiliation

Organization Name PECOS PAC ID Members
Empowerme Rehabilitation Florida, Llc 3274962790 115
Sobe Innovative Rehabilitation Pllc 4789994336 94
Newsletter for Healthcare Professionals

Provider Taxonomy Details

Primary Taxonomy
Taxonomy
License No.
OT21937 (Florida)

Reference NPI Information (as per NPPES NPI Record)

Field Name Field Value
NPI 1093482978
10-position all-numeric identification number assigned by the NPS to uniquely identify a health care provider.
Entity Type Individual
Code describing the type of health care provider that is being assigned an NPI. Codes are:
  • 1 = (Person): individual human being who furnishes health care;
  • 2 = (Non-person): entity other than an individual human being that furnishes health care (for example, hospital, SNF, hospital subunit, pharmacy, or HMO).
Is Sole Proprietor N
Indicate whether provider is a sole proprietor.
  • A sole proprietor is the sole (the only) owner of a business that is not incorporated; that unincorporated business is a sole proprietorship.
  • In a sole proprietorship, the sole proprietor owns all of the assets of the business and is solely liable for all of the debts of the business.
  • There is no difference between a sole proprietorship and a sole proprietor; they are legally a single entity: an individual.
  • In terms of NPI assignment, a sole proprietor is an Entity type 1 (Individual) and is eligible for only one NPI (the sole proprietorship business is not eligible for its own NPI).
  • As an individual, a sole proprietorship cannot be a subpart and cannot have subparts. (See NPI Final Rule for information about subparts.)
  • A sole proprietorship may or may not have employees.
  • Often, the IRS assigns an EIN to a sole proprietorship in order to protect the sole proprietor's SSN from disclosure in claims or on W-2s. NPPES does not capture a sole proprietorship's EIN.
  • Many types of health care providers could be sole proprietorships (for example, group practices, pharmacies, home health agencies).
Provider Last Name (Legal Name) Brackins
The last name of the provider (if an individual). If the provider is an individual, this is the legal name. This name must match the name on file with the Social Security Administration (SSA). In addition, the date of birth must match that on file with SSA. (First and last names are required for initial applications.) The First, Middle, Last and Credential(s) fields allow the following special characters: ampersand, apostrophe, colon, comma, forward slash, hyphen, left and right parentheses, period, pound sign, quotation mark, and semi-colon. A field cannot contain all special characters.
Provider First Name Alexis
The first name of the provider, if the provider is an individual.
Provider Credential Text OTD, OTR/L
The abbreviations for professional degrees or credentials used or held by the provider, if the provider is an individual. Examples are MD, DDS, CSW, CNA, AA, NP, RNA, or PSY. These credential designations will not be verified by NPS.
Provider First Line Business Mailing Address 130 TOWN CENTER BLVD APT 6107
The first line mailing address of the provider being identified. This data element may contain the same information as ''Provider first line location address''.
Provider Business Mailing Address City Name Clermont
The City name in the mailing address of the provider being identified. This data element may contain the same information as ''Provider location address City name''.
Provider Business Mailing Address State Name Florida
The State or Province name in the mailing address of the provider being identified. This data element may contain the same information as ''Provider location address State name''.
Provider Business Mailing Address Postal Code 34714-4448
The postal ZIP or zone code in the mailing address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available. This data element may contain the same information as ''Provider location address postal code''.
Provider Business Mailing Address Country Code US
The country code in the mailing address of the provider being identified. This data element may contain the same information as ''Provider location address country code''.
Provider First Line Business Practice Location Address 40124 HIGHWAY 27 STE 103
The first line location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.
Provider Business Practice Location Address City Name Davenport
The city name in the location address of the provider being identified.
Provider Business Practice Location Address State Name Florida
The State or Province name in the location address of the provider being identified.
Provider Business Practice Location Address Postal Code 33837-5905
The postal ZIP or zone code in the location address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available.
Provider Business Practice Location Address Country Code US
The country code in the location address of the provider being identified.
Provider Business Practice Location Address Telephone Number 863-419-2500
The telephone number associated with the location address of the provider being identified.
Provider Enumeration Date 08/27/2021
The date the provider was assigned a unique identifier (assigned an NPI).
Last Update Date 09/29/2021
The date that a record was last updated or changed.
Provider Gender Code F
The code designating the provider's gender if the provider is a person.
Provider Gender Female
The provider's gender if the provider is a person.
Healthcare Provider Taxonomy Code #1 225X00000X
The Health Care Provider Taxonomy code is a unique alphanumeric code, ten characters in length. The code set is structured into three distinct "Levels" including Provider Type, Classification, and Area of Specialization.
Healthcare Provider Taxonomy 1 An occupational therapist is a person who has graduated from an entry-level occupational therapy program accredited by the Accreditation Council for Occupational Therapy Education (ACOTE) or predecessor organizations, or approved by the World Federation of Occupational Therapists (WFOT), or an equivalent international occupational therapy education program; has successfully completed a period of supervised fieldwork experience required by the occupational therapy program; has passed a nationally recognized entry-level examination for occupational therapists, and fulfills state requirements for licensure, certification, or registration. An occupational therapist provides interventions based on evaluation and which emphasize the therapeutic use of everyday life activities (i.e., occupations) with individuals or groups for the purpose of facilitating participation in roles and situations and in home, school, workplace, community and other settings. Occupational therapy services are provided for the purpose of promoting health and wellness and are provided to those who have or are at risk for developing an illness, injury, disease, disorder, condition, impairment, disability, activity limitation, or participation restriction. Occupational therapists address the physical, cognitive, psychosocial, sensory, and other aspects of occupational performance in a variety of contexts to support engagement in everyday life activities that affect health, well-being, and quality of life.
Healthcare Provider Taxonomy #1
Provider License Number 1 OT21937
Certain taxonomy selections will require you to enter your license number and the state where the license was issued. Select Foreign Country in the state drop down box if the license was issued outside of United States. The License Number field allows the following special characters: ampersand, apostrophe, colon, comma, forward slash, hyphen, left and right parentheses, period, pound sign, quotation mark, and semi-colon. A field cannot contain all special characters. DO NOT report the Social Security Number (SSN), IRS Individual Taxpayer Identification Number (ITIN) in this section.
Provider License Number State Code 1 FL
Provider License Number State Code #1
Healthcare Provider Primary Taxonomy Switch 1 Y
Primary Taxonomy:
  • X - The primary taxonomy switch is Not Answered;
  • Y - The taxonomy is the primary taxonomy (there can be only one per NPI record);
  • N - The taxonomy is not the primary taxonomy.