Provider Demographics
NPI:1629521331
Name:RALSTON, BRIDGET C
Entity Type:Individual
Prefix:
First Name:BRIDGET
Middle Name:C
Last Name:RALSTON
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 1:1450 5TH ST SE
Mailing Address - Street 2:SUITE 4400/ MS 1450-4-PT
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98372-4602
Mailing Address - Country:US
Mailing Address - Phone:253-697-2340
Mailing Address - Fax:
Practice Address - Street 1:1450 5TH ST SE
Practice Address - Street 2:SUITE 4400/ MS 1450-4-PT
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98372-4602
Practice Address - Country:US
Practice Address - Phone:253-697-2340
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-28
Last Update Date:2016-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOT60086242225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist