Provider Demographics
NPI:1295247567
Name:BRIDGES, BROOKLYN (MS, OTR/L)
Entity type:Individual
Prefix:
First Name:BROOKLYN
Middle Name:
Last Name:BRIDGES
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 1:292 S PINE ST STE A
Mailing Address - Street 2:
Mailing Address - City:SPARTANBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29302-2673
Mailing Address - Country:US
Mailing Address - Phone:864-591-3484
Mailing Address - Fax:864-751-4115
Practice Address - Street 1:292 S PINE ST STE A
Practice Address - Street 2:
Practice Address - City:SPARTANBURG
Practice Address - State:SC
Practice Address - Zip Code:29302-2673
Practice Address - Country:US
Practice Address - Phone:864-591-3484
Practice Address - Fax:864-751-4115
Is Sole Proprietor?:No
Enumeration Date:2017-10-26
Last Update Date:2017-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC5060225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist