Provider Demographics
NPI:1093161945
Name:FLYNN, BRIDIE (COTA/L)
Entity Type:Individual
Prefix:
First Name:BRIDIE
Middle Name:
Last Name:FLYNN
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2578 ENTERPRISE RD # 116
Mailing Address - Street 2:
Mailing Address - City:ORANGE CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32763-7904
Mailing Address - Country:US
Mailing Address - Phone:386-747-7718
Mailing Address - Fax:
Practice Address - Street 1:2578 ENTERPRISE RD # 116
Practice Address - Street 2:
Practice Address - City:ORANGE CITY
Practice Address - State:FL
Practice Address - Zip Code:32763-7904
Practice Address - Country:US
Practice Address - Phone:386-747-7718
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-05-10
Last Update Date:2016-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant