Provider Demographics
NPI:1548401052
Name:BRIDGES PARENT, LESLIE S (OTR)
Entity Type:Individual
Prefix:
First Name:LESLIE
Middle Name:S
Last Name:BRIDGES PARENT
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 1:44 HATCHETTS HILL RD
Mailing Address - Street 2:
Mailing Address - City:OLD LYME
Mailing Address - State:CT
Mailing Address - Zip Code:06371-1512
Mailing Address - Country:US
Mailing Address - Phone:860-434-4800
Mailing Address - Fax:860-434-4834
Practice Address - Street 1:44 HATCHETTS HILL RD
Practice Address - Street 2:
Practice Address - City:OLD LYME
Practice Address - State:CT
Practice Address - Zip Code:06371-1512
Practice Address - Country:US
Practice Address - Phone:860-434-4800
Practice Address - Fax:860-434-4834
Is Sole Proprietor?:No
Enumeration Date:2009-03-12
Last Update Date:2009-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT002598225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT1922123314OtherNPI