Provider Demographics
NPI:1477766491
Name:SMITH, BRIDGETTE MICHELLE
Entity Type:Individual
Prefix:
First Name:BRIDGETTE
Middle Name:MICHELLE
Last Name:SMITH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:CARING HANDS
Other - Middle Name:
Other - Last Name:INTERVENTION SERVICES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 203
Mailing Address - Street 2:270 L CONLEY CEMETARY RD
Mailing Address - City:MOUSIE
Mailing Address - State:KY
Mailing Address - Zip Code:41839-0203
Mailing Address - Country:US
Mailing Address - Phone:606-946-2591
Mailing Address - Fax:
Practice Address - Street 1:270 L CONLEY CEM RD
Practice Address - Street 2:
Practice Address - City:MOUSIE
Practice Address - State:KY
Practice Address - Zip Code:41839-8919
Practice Address - Country:US
Practice Address - Phone:606-946-2591
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-07
Last Update Date:2021-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
222Q00000X
KY273320235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
No222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist