Provider Demographics
NPI:1154754075
Name:FYLE, BRIDGET (MA OTR/L)
Entity type:Individual
Prefix:
First Name:BRIDGET
Middle Name:
Last Name:FYLE
Suffix:
Gender:F
Credentials:MA OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1727 WHITAKER ST
Mailing Address - Street 2:
Mailing Address - City:WHITE BEAR LAKE
Mailing Address - State:MN
Mailing Address - Zip Code:55110-3767
Mailing Address - Country:US
Mailing Address - Phone:612-203-3339
Mailing Address - Fax:
Practice Address - Street 1:505 88TH DIVISION RD
Practice Address - Street 2:785TH COSC
Practice Address - City:FT SNELLING
Practice Address - State:MN
Practice Address - Zip Code:55111-4008
Practice Address - Country:US
Practice Address - Phone:612-558-5546
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-14
Last Update Date:2020-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN104336225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist