Provider Demographics
NPI:1407248735
Name:DAVIS, BRIDGET THERESA (AUD)
Entity type:Individual
Prefix:DR
First Name:BRIDGET
Middle Name:THERESA
Last Name:DAVIS
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:BRIDGET
Other - Middle Name:THERESA
Other - Last Name:LAFFIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:AUD
Mailing Address - Street 1:2000 S WHEELING AVE STE 900
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74104-5647
Mailing Address - Country:US
Mailing Address - Phone:918-403-6284
Mailing Address - Fax:918-403-6323
Practice Address - Street 1:2000 S WHEELING AVE STE 900
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74104-5647
Practice Address - Country:US
Practice Address - Phone:918-403-6284
Practice Address - Fax:918-403-6323
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-24
Last Update Date:2021-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MASP-1057-AU231H00000X
OK5257231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAS400200947Medicare PIN