Provider Demographics
NPI:1841653045
Name:WAGERS, BRIDGETT (OTRL)
Entity type:Individual
Prefix:MRS
First Name:BRIDGETT
Middle Name:
Last Name:WAGERS
Suffix:
Gender:F
Credentials:OTRL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3004 OLD UNION SPRINGS DR
Mailing Address - Street 2:
Mailing Address - City:LONDON
Mailing Address - State:KY
Mailing Address - Zip Code:40744-8103
Mailing Address - Country:US
Mailing Address - Phone:606-309-4694
Mailing Address - Fax:
Practice Address - Street 1:3004 OLD UNION SPRINGS DR
Practice Address - Street 2:
Practice Address - City:LONDON
Practice Address - State:KY
Practice Address - Zip Code:40744-8103
Practice Address - Country:US
Practice Address - Phone:606-309-4694
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-04-04
Last Update Date:2016-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYR3167225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist