MEDICARE: BRIDGET LEE O'BRIEN OTR/L

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225X00000X	Occupational Therapist	056006398	IL
2	225X00000X	Occupational Therapist	2001014964	MO

General Provider Information

NPI Number	:	1053416792
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRIDGET LEE O'BRIEN OTR/L

Provider Business Mailing Address
First Line	:	9115 MORITZ AVE
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63144-1625
Country	:	US
Telephone Number	:	314-918-7814
Fax Number	:	314-918-8444

Provider Business Practice Location Address
First Line	:	8030 ROSILINE DR
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63105-2545
Country	:	US
Telephone Number	:	314-578-6255
Fax Number	:	314-725-2328

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/14/2006
Last Update Date	:	04/03/2019

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