MEDICARE: BRIDGING THE GAP PEDIATRIC THERAPY

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	2355S0801X	Speech-Language Assistant	02995336	TX
2	225XP0200X	Pediatric Occupational Therapist	110793	TX

General Provider Information

NPI Number	:	1528339637
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BRIDGING THE GAP PEDIATRIC THERAPY

Provider Business Mailing Address
First Line	:	7646 UMBRA HTS
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78252-2256
Country	:	US
Telephone Number	:	210-317-6460
Fax Number	:

Provider Business Practice Location Address
First Line	:	7646 UMBRA HTS
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78252-2256
Country	:	US
Telephone Number	:	210-317-6460
Fax Number	:

Authorized Official
Title or Position	:	OCCUPATIONAL THERAPIST
Name	:	STACEY KATHLEEN OROSCO
Credential	:	OTR
Telephone Number	:	210-317-6460

Provider Enumeration Date	:	01/20/2012
Last Update Date	:	01/24/2012

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Directions to “BRIDGING THE GAP PEDIATRIC THERAPY ” Practice Location

Language	Start Address	Practice Location

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