Provider Demographics
NPI:1164508651
Name:ELIJAH, BRIDGET ROSE (OTR)
Entity Type:Individual
Prefix:MRS
First Name:BRIDGET
Middle Name:ROSE
Last Name:ELIJAH
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30412 COUNTY ROAD 8
Mailing Address - Street 2:
Mailing Address - City:ELKHART
Mailing Address - State:IN
Mailing Address - Zip Code:46514-9742
Mailing Address - Country:US
Mailing Address - Phone:574-262-0445
Mailing Address - Fax:
Practice Address - Street 1:30412 COUNTY ROAD 8
Practice Address - Street 2:
Practice Address - City:ELKHART
Practice Address - State:IN
Practice Address - Zip Code:46514-9742
Practice Address - Country:US
Practice Address - Phone:574-262-0445
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN31000366A225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist