Provider Demographics
NPI:1639472707
Name:PERRY, BRIDGET (OTA)
Entity Type:Individual
Prefix:
First Name:BRIDGET
Middle Name:
Last Name:PERRY
Suffix:
Gender:F
Credentials:OTA
Other - Prefix:
Other - First Name:BRIDGET
Other - Middle Name:
Other - Last Name:CROSS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:617 W MAIN ST APT A
Mailing Address - Street 2:
Mailing Address - City:EL DORADO
Mailing Address - State:AR
Mailing Address - Zip Code:71730-5713
Mailing Address - Country:US
Mailing Address - Phone:870-864-0411
Mailing Address - Fax:870-864-0411
Practice Address - Street 1:617 W MAIN ST APT A
Practice Address - Street 2:
Practice Address - City:EL DORADO
Practice Address - State:AR
Practice Address - Zip Code:71730-5713
Practice Address - Country:US
Practice Address - Phone:870-864-0411
Practice Address - Fax:870-864-0411
Is Sole Proprietor?:No
Enumeration Date:2010-12-13
Last Update Date:2013-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARO-T1081224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant