Provider Demographics
NPI:1396317269
Name:BRIDGES, SHELLEY SUSANNE (OTR/L)
Entity type:Individual
Prefix:
First Name:SHELLEY
Middle Name:SUSANNE
Last Name:BRIDGES
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 1:307 INTERNATIONAL CIR STE 100
Mailing Address - Street 2:
Mailing Address - City:COCKEYSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21030-1387
Mailing Address - Country:US
Mailing Address - Phone:877-508-3237
Mailing Address - Fax:
Practice Address - Street 1:1911 ORANGE GROVE RD
Practice Address - Street 2:
Practice Address - City:HILLSBOROUGH
Practice Address - State:NC
Practice Address - Zip Code:27278-9582
Practice Address - Country:US
Practice Address - Phone:919-888-4114
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-12
Last Update Date:2021-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1738225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist