Provider Demographics
NPI:1548386444
Name:MOORE, BRIDGET ANN (MSOTRL)
Entity Type:Individual
Prefix:
First Name:BRIDGET
Middle Name:ANN
Last Name:MOORE
Suffix:
Gender:F
Credentials:MSOTRL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 927
Mailing Address - Street 2:
Mailing Address - City:BRUNSWICK
Mailing Address - State:ME
Mailing Address - Zip Code:04011-0927
Mailing Address - Country:US
Mailing Address - Phone:207-240-3255
Mailing Address - Fax:
Practice Address - Street 1:22 NORTHBROOK DR
Practice Address - Street 2:
Practice Address - City:FALMOUTH
Practice Address - State:ME
Practice Address - Zip Code:04105-1318
Practice Address - Country:US
Practice Address - Phone:207-781-5775
Practice Address - Fax:207-781-2987
Is Sole Proprietor?:No
Enumeration Date:2007-03-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEOT1559225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist