Provider Demographics
NPI:1285166918
Name:ETHRIDGE, BRITNEY
Entity type:Individual
Prefix:
First Name:BRITNEY
Middle Name:
Last Name:ETHRIDGE
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 1:2235 TENBRINK DR
Mailing Address - Street 2:
Mailing Address - City:ROLLA
Mailing Address - State:MO
Mailing Address - Zip Code:65401-2405
Mailing Address - Country:US
Mailing Address - Phone:573-202-2713
Mailing Address - Fax:573-426-3610
Practice Address - Street 1:2235 TENBRINK DR
Practice Address - Street 2:
Practice Address - City:ROLLA
Practice Address - State:MO
Practice Address - Zip Code:65401-2405
Practice Address - Country:US
Practice Address - Phone:573-202-2713
Practice Address - Fax:573-426-3610
Is Sole Proprietor?:No
Enumeration Date:2017-03-31
Last Update Date:2017-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2013032213225XG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XG0600XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGerontology