Provider Demographics
NPI:1417011255
Name:BRIDEAU, COURTNEY ANN (MS, OTR)
Entity type:Individual
Prefix:
First Name:COURTNEY
Middle Name:ANN
Last Name:BRIDEAU
Suffix:
Gender:
Credentials:MS, OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:45 FOREST AVE
Mailing Address - Street 2:
Mailing Address - City:BANGOR
Mailing Address - State:ME
Mailing Address - Zip Code:04401-5313
Mailing Address - Country:US
Mailing Address - Phone:207-941-6280
Mailing Address - Fax:
Practice Address - Street 1:45 FOREST AVE
Practice Address - Street 2:
Practice Address - City:BANGOR
Practice Address - State:ME
Practice Address - Zip Code:04401-5313
Practice Address - Country:US
Practice Address - Phone:207-941-6280
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-19
Last Update Date:2025-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEOT1752225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME431784199Medicaid