Provider Demographics
NPI:1639451503
Name:BIRD, BRIGETTE (OTR/L)
Entity type:Individual
Prefix:
First Name:BRIGETTE
Middle Name:
Last Name:BIRD
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:BRIGETTE
Other - Middle Name:
Other - Last Name:BRODEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8408 SOUTH COLENE DR
Mailing Address - Street 2:
Mailing Address - City:SANDY
Mailing Address - State:UT
Mailing Address - Zip Code:84094
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8408 COLENE DR
Practice Address - Street 2:
Practice Address - City:SANDY
Practice Address - State:UT
Practice Address - Zip Code:84094-1319
Practice Address - Country:US
Practice Address - Phone:801-649-7334
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-15
Last Update Date:2011-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT7360507-4201208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation