Provider Demographics
NPI:1598810301
Name:BERHORST, BRIDGET MAUREEN (OT)
Entity Type:Individual
Prefix:MRS
First Name:BRIDGET
Middle Name:MAUREEN
Last Name:BERHORST
Suffix:
Gender:F
Credentials:OT
Other - Prefix:MS
Other - First Name:BRIDGET
Other - Middle Name:MAUREEN
Other - Last Name:SCHROEGER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:502 MIDDLETON DR.
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:MO
Mailing Address - Zip Code:65010-9096
Mailing Address - Country:US
Mailing Address - Phone:573-657-2184
Mailing Address - Fax:
Practice Address - Street 1:1115 FAIRGROUNDS RD
Practice Address - Street 2:
Practice Address - City:JEFFERSON CITY
Practice Address - State:MO
Practice Address - Zip Code:65109-5443
Practice Address - Country:US
Practice Address - Phone:573-634-3070
Practice Address - Fax:573-636-3247
Is Sole Proprietor?:No
Enumeration Date:2007-01-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2000175714225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist