Provider Demographics
NPI:1669147633
Name:BARGO, PAIGE
Entity type:Individual
Prefix:MRS
First Name:PAIGE
Middle Name:
Last Name:BARGO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17497 LEBANON RD
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33967-2906
Mailing Address - Country:US
Mailing Address - Phone:407-247-2141
Mailing Address - Fax:
Practice Address - Street 1:3250 WINKLER AVE
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33916-9414
Practice Address - Country:US
Practice Address - Phone:239-939-4993
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-12
Last Update Date:2021-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225X00000X
FL21357225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist