Healthcare Provider Details

I. General information

NPI: 1356967889
Provider Name (Legal Business Name): BRIDGET A BREEN OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/20/2020
Last Update Date: 06/25/2020
Certification Date: 06/25/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

685 RIVER AVE
LAKEWOOD NJ
08701-5288
US

IV. Provider business mailing address

1790 MEADOW GLEN DR
LANSDALE PA
19446-4743
US

V. Phone/Fax

Practice location:
  • Phone: 732-367-3667
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code225XP0019X
TaxonomyPhysical Rehabilitation Occupational Therapist
License NumberOC016494
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: