Provider Demographics
NPI:1568597938
Name:BRIDGES, DEBORAH K (OTR L)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:K
Last Name:BRIDGES
Suffix:
Gender:F
Credentials:OTR L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5801 STATE ROUTE 2
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:MO
Mailing Address - Zip Code:64734-8109
Mailing Address - Country:US
Mailing Address - Phone:816-250-2994
Mailing Address - Fax:816-899-2823
Practice Address - Street 1:5801 STATE ROUTE 2
Practice Address - Street 2:COUNTY OF CASS SCHOOL DISTRICT
Practice Address - City:CLEVELAND
Practice Address - State:MO
Practice Address - Zip Code:64734-8109
Practice Address - Country:US
Practice Address - Phone:816-250-2994
Practice Address - Fax:816-899-2823
Is Sole Proprietor?:No
Enumeration Date:2007-02-23
Last Update Date:2009-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO000061225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO477473201Medicaid