Healthcare Provider Details

I. General information

NPI: 1154070118
Provider Name (Legal Business Name): BRIDGES SPECTRUM THERAPY LLC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/18/2022
Last Update Date: 10/29/2024
Certification Date: 10/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13019 PAULINE DR
SHELBY TOWNSHIP MI
48315-3122
US

IV. Provider business mailing address

13019 PAULINE DR
SHELBY TOWNSHIP MI
48315-3122
US

V. Phone/Fax

Practice location:
  • Phone: 888-770-7240
  • Fax: 248-403-8506
Mailing address:
  • Phone: 888-770-7240
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: CHRISTIAN MARRIOTT
Title or Position: DIRECTOR OF OPERATIONS
Credential:
Phone: 888-770-7240