MEDICARE: BRIDIE FLYNN COTA/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	224Z00000X	Occupational Therapy Assistant

General Provider Information

NPI Number	:	1093161945
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRIDIE FLYNN COTA/L

Provider Business Mailing Address
First Line	:	2578 ENTERPRISE RD # 116
Second Line	:
City	:	ORANGE CITY
State	:	FL
Zip	:	32763-7904
Country	:	US
Telephone Number	:	386-747-7718
Fax Number	:

Provider Business Practice Location Address
First Line	:	2578 ENTERPRISE RD # 116
Second Line	:
City	:	ORANGE CITY
State	:	FL
Zip	:	32763-7904
Country	:	US
Telephone Number	:	386-747-7718
Fax Number	:

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

Provider Enumeration Date	:	05/10/2016
Last Update Date	:	05/10/2016

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Directions to “ BRIDIE FLYNN COTA/L” Practice Location

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