Provider Demographics
NPI:1801045067
Name:BRIDGELALL, ANNE (OTR/L)
Entity Type:Individual
Prefix:MS
First Name:ANNE
Middle Name:
Last Name:BRIDGELALL
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8655 110TH ST
Mailing Address - Street 2:
Mailing Address - City:RICHMOND HILL
Mailing Address - State:NY
Mailing Address - Zip Code:11418-1630
Mailing Address - Country:US
Mailing Address - Phone:917-696-4536
Mailing Address - Fax:
Practice Address - Street 1:8655 110TH ST
Practice Address - Street 2:
Practice Address - City:RICHMOND HILL
Practice Address - State:NY
Practice Address - Zip Code:11418-1630
Practice Address - Country:US
Practice Address - Phone:917-696-4536
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-11
Last Update Date:2008-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008243-1174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist