Provider Demographics
NPI:1740514587
Name:LEO, BRIDGET JANE (OTR)
Entity type:Individual
Prefix:
First Name:BRIDGET
Middle Name:JANE
Last Name:LEO
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:BRIDGET
Other - Middle Name:JANE
Other - Last Name:BREEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR
Mailing Address - Street 1:2222 SULLIVAN TRL
Mailing Address - Street 2:
Mailing Address - City:EASTON
Mailing Address - State:PA
Mailing Address - Zip Code:18040-7958
Mailing Address - Country:US
Mailing Address - Phone:800-944-9782
Mailing Address - Fax:610-438-2024
Practice Address - Street 1:2341 W NORVELL BRYANT HWY
Practice Address - Street 2:
Practice Address - City:LECANTO
Practice Address - State:FL
Practice Address - Zip Code:34461-9438
Practice Address - Country:US
Practice Address - Phone:352-746-2273
Practice Address - Fax:351-746-4166
Is Sole Proprietor?:No
Enumeration Date:2009-09-28
Last Update Date:2009-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT12238225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist