Provider Demographics
NPI:1225509193
Name:SEALE, BRIDGET RENE
Entity Type:Individual
Prefix:
First Name:BRIDGET
Middle Name:RENE
Last Name:SEALE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:BRIDGET
Other - Middle Name:RENE
Other - Last Name:HAINES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:760 BAY BROOKE CT
Mailing Address - Street 2:
Mailing Address - City:VANDALIA
Mailing Address - State:OH
Mailing Address - Zip Code:45377-1515
Mailing Address - Country:US
Mailing Address - Phone:303-301-5871
Mailing Address - Fax:
Practice Address - Street 1:1750 COMMERCE CENTER BLVD
Practice Address - Street 2:
Practice Address - City:FAIRBORN
Practice Address - State:OH
Practice Address - Zip Code:45324-6333
Practice Address - Country:US
Practice Address - Phone:937-878-8444
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-17
Last Update Date:2018-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician