Provider Demographics
NPI:1275171498
Name:BAINBRIDGE PEDIATRIC THERAPY
Entity Type:Organization
Organization Name:BAINBRIDGE PEDIATRIC THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OTR/OWER BAINBRIDGE PED THERAPY
Authorized Official - Prefix:
Authorized Official - First Name:VALERIE
Authorized Official - Middle Name:
Authorized Official - Last Name:BAUTISTA
Authorized Official - Suffix:
Authorized Official - Credentials:OTR
Authorized Official - Phone:206-972-0648
Mailing Address - Street 1:7829 NE ESPERIONE LN
Mailing Address - Street 2:
Mailing Address - City:BAINBRIDGE ISLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98110-2650
Mailing Address - Country:US
Mailing Address - Phone:206-972-0648
Mailing Address - Fax:
Practice Address - Street 1:1173 MADISON AVE N
Practice Address - Street 2:
Practice Address - City:BAINBRIDGE ISLAND
Practice Address - State:WA
Practice Address - Zip Code:98110-1782
Practice Address - Country:US
Practice Address - Phone:206-972-0648
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-12-18
Last Update Date:2019-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatricsGroup - Single Specialty