Healthcare Provider Details

I. General information

NPI: 1235947185
Provider Name (Legal Business Name): BRIDGET JAE REUSS OTR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/24/2024
Last Update Date: 12/24/2024
Certification Date: 12/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 PETERSON PKWY
NEW LONDON MN
56273-7838
US

IV. Provider business mailing address

19 CENTRAL AVE
BUFFALO MN
55313-1569
US

V. Phone/Fax

Practice location:
  • Phone: 952-955-2242
  • Fax: 952-955-2010
Mailing address:
  • Phone: 922-955-2242
  • Fax: 952-955-2010

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number107308
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: