Provider Demographics
NPI:1679046262
Name:MURPHY, BRIDGITTE ANN
Entity Type:Individual
Prefix:
First Name:BRIDGITTE
Middle Name:ANN
Last Name:MURPHY
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 1:21399 TULANE AVE APT 302
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48336-5677
Mailing Address - Country:US
Mailing Address - Phone:313-917-5476
Mailing Address - Fax:
Practice Address - Street 1:21399 TULANE AVE APT 302
Practice Address - Street 2:
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48336-5677
Practice Address - Country:US
Practice Address - Phone:313-917-5476
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-07
Last Update Date:2019-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI520222001235224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5202001235Medicaid