Healthcare Provider Details

I. General information

NPI: 1528826138
Provider Name (Legal Business Name): BRIDGETT TEGEN OTR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/08/2024
Last Update Date: 03/08/2024
Certification Date: 03/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

480 HIGHWAY 96 E STE 120
VADNAIS HEIGHTS MN
55127-2557
US

IV. Provider business mailing address

2404 DUPONT AVE S APT 3
MINNEAPOLIS MN
55405-3087
US

V. Phone/Fax

Practice location:
  • Phone: 651-482-8486
  • Fax:
Mailing address:
  • Phone: 612-910-2295
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number107401
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: