Provider Demographics
NPI:1558571745
Name:SLAUGHTER, BRIDGET L (OT/L)
Entity Type:Individual
Prefix:
First Name:BRIDGET
Middle Name:L
Last Name:SLAUGHTER
Suffix:
Gender:F
Credentials:OT/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1128 W OCEAN VIEW AVE UNIT L
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23503-1211
Mailing Address - Country:US
Mailing Address - Phone:972-948-6285
Mailing Address - Fax:
Practice Address - Street 1:637 KINGSBOROUGH SQ STE A
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23320-4944
Practice Address - Country:US
Practice Address - Phone:757-698-4681
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-23
Last Update Date:2023-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX102726225X00000X
VA0119009645225XP0019X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0019XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPhysical Rehabilitation
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist