Healthcare Provider Details

I. General information

NPI: 1053599431
Provider Name (Legal Business Name): BRIDGET COLLEEN CARUSO OT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/07/2008
Last Update Date: 03/01/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

E 65TH ST @ LAKE MICHIGAN
CHICAGO IL
60649
US

IV. Provider business mailing address

3758 N SHEFFIELD AVE
CHICAGO IL
60613-5037
US

V. Phone/Fax

Practice location:
  • Phone: 773-256-5796
  • Fax:
Mailing address:
  • Phone: 773-562-8005
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code222Q00000X
TaxonomyDevelopmental Therapist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number056005923
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: