Provider Demographics
NPI:1205093135
Name:PETTIFORD, BRIDGET MARIE (OTR/L)
Entity type:Individual
Prefix:MRS
First Name:BRIDGET
Middle Name:MARIE
Last Name:PETTIFORD
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 1:200 NORTHPOINTE CIR
Mailing Address - Street 2:STE. 302
Mailing Address - City:SEVEN FIELDS
Mailing Address - State:PA
Mailing Address - Zip Code:16046-7861
Mailing Address - Country:US
Mailing Address - Phone:800-815-8577
Mailing Address - Fax:724-779-6407
Practice Address - Street 1:6336 CEDAR LN
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21044-3897
Practice Address - Country:US
Practice Address - Phone:410-531-6000
Practice Address - Fax:410-531-3402
Is Sole Proprietor?:No
Enumeration Date:2008-05-19
Last Update Date:2008-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD05068225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist