Provider Demographics
NPI:1639766454
Name:MATHIS, BRIDGET (OTR)
Entity Type:Individual
Prefix:
First Name:BRIDGET
Middle Name:
Last Name:MATHIS
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 1:818 WYNDCREST DR
Mailing Address - Street 2:
Mailing Address - City:TEMPLE
Mailing Address - State:TX
Mailing Address - Zip Code:76502-2079
Mailing Address - Country:US
Mailing Address - Phone:203-444-2404
Mailing Address - Fax:
Practice Address - Street 1:3405 EL SALIDO PKWY
Practice Address - Street 2:
Practice Address - City:CEDAR PARK
Practice Address - State:TX
Practice Address - Zip Code:78613-5640
Practice Address - Country:US
Practice Address - Phone:512-402-5040
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-28
Last Update Date:2021-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX114989225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist