Provider Demographics
NPI:1689990210
Name:FITZPATRICK, BRIDGET JEAN (MS,OTR/L)
Entity Type:Individual
Prefix:MS
First Name:BRIDGET
Middle Name:JEAN
Last Name:FITZPATRICK
Suffix:
Gender:F
Credentials:MS,OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 COMMUNITY DR
Mailing Address - Street 2:SUITE 207
Mailing Address - City:TOBYHANNA
Mailing Address - State:PA
Mailing Address - Zip Code:18466-8985
Mailing Address - Country:US
Mailing Address - Phone:570-839-9975
Mailing Address - Fax:570-839-9274
Practice Address - Street 1:100 COMMUNITY DR
Practice Address - Street 2:SUITE 105
Practice Address - City:TOBYHANNA
Practice Address - State:PA
Practice Address - Zip Code:18466-8985
Practice Address - Country:US
Practice Address - Phone:570-839-9975
Practice Address - Fax:570-839-9274
Is Sole Proprietor?:No
Enumeration Date:2010-04-07
Last Update Date:2010-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOC011400225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA394532OtherMEDICARE