Provider Demographics
NPI:1629556246
Name:WOODMAN, BRIDGET VALLERY ANN (OTR)
Entity Type:Individual
Prefix:
First Name:BRIDGET
Middle Name:VALLERY ANN
Last Name:WOODMAN
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6201 KNOB BEND DR
Mailing Address - Street 2:
Mailing Address - City:GRAND BLANC
Mailing Address - State:MI
Mailing Address - Zip Code:48439-7459
Mailing Address - Country:US
Mailing Address - Phone:810-845-3712
Mailing Address - Fax:
Practice Address - Street 1:1330 GRAND POINTE CT
Practice Address - Street 2:
Practice Address - City:GRAND BLANC
Practice Address - State:MI
Practice Address - Zip Code:48439-5502
Practice Address - Country:US
Practice Address - Phone:810-695-8920
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-06
Last Update Date:2018-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5201004126225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist