Healthcare Provider Details

I. General information

NPI: 1447648621
Provider Name (Legal Business Name): BRIDGET ANN DINNEEN OTR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/23/2014
Last Update Date: 12/23/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

203 E LASLEY ST
SAINT MARYS KS
66536-1739
US

IV. Provider business mailing address

203 E LASLEY ST
SAINT MARYS KS
66536-1739
US

V. Phone/Fax

Practice location:
  • Phone: 785-437-2008
  • Fax:
Mailing address:
  • Phone: 785-437-2008
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XG0600X
TaxonomyGerontology Occupational Therapist
License Number17-02491
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: