Provider Demographics
NPI:1588157770
Name:EASON, BRIDGET RENEE
Entity type:Individual
Prefix:
First Name:BRIDGET
Middle Name:RENEE
Last Name:EASON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:BRIDGET
Other - Middle Name:RENEE
Other - Last Name:TRACEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:160 N NC 241 HWY # 24
Mailing Address - Street 2:
Mailing Address - City:BEULAVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28518-8636
Mailing Address - Country:US
Mailing Address - Phone:910-298-2331
Mailing Address - Fax:910-375-3031
Practice Address - Street 1:160 N NC 241 HWY
Practice Address - Street 2:
Practice Address - City:BEULAVILLE
Practice Address - State:NC
Practice Address - Zip Code:28518-8636
Practice Address - Country:US
Practice Address - Phone:910-298-2331
Practice Address - Fax:910-375-3031
Is Sole Proprietor?:No
Enumeration Date:2018-06-12
Last Update Date:2023-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOC015311225X00000X
NC11690225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist