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NPI Code Detail

MEDICARE: MRS. LAURIE CLARK BRIDGES OTR

MEDICARE: MRS. LAURIE CLARK BRIDGES OTR
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
1225X00000XOccupational TherapistOTT.Z11887LA

General Provider Information

NPI Number : 1538357678
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. LAURIE CLARK BRIDGES OTR
Provider Business Mailing Address
First Line : 19100 W LAKE HOUSTON PKWY STE 104
Second Line :
City : HUMBLE
State : TX
Zip : 77346-5139
Country : US
Telephone Number : 281-812-9519
Fax Number : 281-812-5719
Provider Business Practice Location Address
First Line : 19100 W LAKE HOUSTON PKWY STE 104
Second Line :
City : HUMBLE
State : TX
Zip : 77346-5139
Country : US
Telephone Number : 281-812-9519
Fax Number : 281-812-5719
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/12/2007
Last Update Date : 10/12/2007

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