Provider Demographics
NPI:1619605227
Name:RASCOE, BRIDGET GILLIS
Entity Type:Individual
Prefix:
First Name:BRIDGET
Middle Name:GILLIS
Last Name:RASCOE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13 BELLEFIELD LN
Mailing Address - Street 2:
Mailing Address - City:CLAYTON
Mailing Address - State:NC
Mailing Address - Zip Code:27527-8313
Mailing Address - Country:US
Mailing Address - Phone:252-814-3574
Mailing Address - Fax:
Practice Address - Street 1:195 SPRINGBROOK AVE
Practice Address - Street 2:
Practice Address - City:CLAYTON
Practice Address - State:NC
Practice Address - Zip Code:27520-8105
Practice Address - Country:US
Practice Address - Phone:912-550-7200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-11
Last Update Date:2022-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9611224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant