Provider Demographics
NPI:1538829304
Name:MARTINEZ, BRIDGET RACHELLE (OTR)
Entity type:Individual
Prefix:
First Name:BRIDGET
Middle Name:RACHELLE
Last Name:MARTINEZ
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:BRIDGET
Other - Middle Name:RACHELLE
Other - Last Name:HAVENS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:205 W MILL ST
Mailing Address - Street 2:
Mailing Address - City:CYNTHIANA
Mailing Address - State:KY
Mailing Address - Zip Code:41031-1045
Mailing Address - Country:US
Mailing Address - Phone:606-316-8525
Mailing Address - Fax:
Practice Address - Street 1:205 W MILL ST
Practice Address - Street 2:
Practice Address - City:CYNTHIANA
Practice Address - State:KY
Practice Address - Zip Code:41031-1045
Practice Address - Country:US
Practice Address - Phone:606-316-8525
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-21
Last Update Date:2021-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY273142225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist