Provider Demographics
NPI:1013493519
Name:BRIDGE, ALEXA JADE (MS, OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:ALEXA
Middle Name:JADE
Last Name:BRIDGE
Suffix:
Gender:F
Credentials:MS, OTR/L
Other - Prefix:MISS
Other - First Name:ALEXA
Other - Middle Name:JADE
Other - Last Name:SHAFFER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, OTR/L
Mailing Address - Street 1:PO BOX 6
Mailing Address - Street 2:
Mailing Address - City:WALSTON
Mailing Address - State:PA
Mailing Address - Zip Code:15781-0006
Mailing Address - Country:US
Mailing Address - Phone:814-952-6911
Mailing Address - Fax:
Practice Address - Street 1:1464 N MAIN ST STE 14
Practice Address - Street 2:
Practice Address - City:PUNXSUTAWNEY
Practice Address - State:PA
Practice Address - Zip Code:15767-2609
Practice Address - Country:US
Practice Address - Phone:814-249-7028
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-17
Last Update Date:2020-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOC015736225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist