Healthcare Provider Details

I. General information

NPI: 1831599182
Provider Name (Legal Business Name): BRIDGETTE OBRIEN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/23/2014
Last Update Date: 08/23/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

675 W WASHINGTON AVE
MADISON WI
53703-2637
US

IV. Provider business mailing address

675 W WASHINGTON AVE
MADISON WI
53703-2637
US

V. Phone/Fax

Practice location:
  • Phone: 608-257-9700
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number12454-146
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: