Provider Demographics
NPI:1053416792
Name:O'BRIEN, BRIDGET LEE (OTR/L)
Entity type:Individual
Prefix:
First Name:BRIDGET
Middle Name:LEE
Last Name:O'BRIEN
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9115 MORITZ AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63144-1625
Mailing Address - Country:US
Mailing Address - Phone:314-918-7814
Mailing Address - Fax:314-918-8444
Practice Address - Street 1:8030 ROSILINE DR
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63105-2545
Practice Address - Country:US
Practice Address - Phone:314-578-6255
Practice Address - Fax:314-725-2328
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-14
Last Update Date:2019-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL056006398225X00000X
MO2001014964225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist