Provider Demographics
NPI:1689269797
Name:REYNOLDS, BRIDGET V (MT-BC)
Entity type:Individual
Prefix:
First Name:BRIDGET
Middle Name:V
Last Name:REYNOLDS
Suffix:
Gender:F
Credentials:MT-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:68 1/2 WALNUT ST REAR UNIT
Mailing Address - Street 2:
Mailing Address - City:EAST PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02914-4426
Mailing Address - Country:US
Mailing Address - Phone:401-321-4408
Mailing Address - Fax:
Practice Address - Street 1:68 1/2 WALNUT ST REAR UNIT
Practice Address - Street 2:
Practice Address - City:EAST PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02914-4426
Practice Address - Country:US
Practice Address - Phone:401-321-4408
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-02
Last Update Date:2024-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RI18212225A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic Therapist