Healthcare Provider Details

I. General information

NPI: 1568866556
Provider Name (Legal Business Name): BRIDGET NICOLE MINNICK OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/20/2014
Last Update Date: 01/25/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4202 PEACH ST
ERIE PA
16509-1458
US

IV. Provider business mailing address

4202 PEACH ST
ERIE PA
16509-1458
US

V. Phone/Fax

Practice location:
  • Phone: 814-833-2301
  • Fax: 814-833-9230
Mailing address:
  • Phone: 814-833-2301
  • Fax: 814-833-9230

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XR0403X
TaxonomyDriving and Community Mobility Occupational Therapist
License NumberOC013335
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: