Provider Demographics
NPI:1649788019
Name:CHALILA, BRIDGETTE AILEEN (OT)
Entity type:Individual
Prefix:
First Name:BRIDGETTE
Middle Name:AILEEN
Last Name:CHALILA
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 NORWAY RD
Mailing Address - Street 2:
Mailing Address - City:BANGOR
Mailing Address - State:ME
Mailing Address - Zip Code:04401-5817
Mailing Address - Country:US
Mailing Address - Phone:207-947-3737
Mailing Address - Fax:
Practice Address - Street 1:78 MAIN RD
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:ME
Practice Address - Zip Code:04461-3605
Practice Address - Country:US
Practice Address - Phone:207-947-7700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-18
Last Update Date:2018-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEOT3391225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist