Basic Information
| Provider Information | |||||||||
| NPI: | 1588035588 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LEHFELDT | ||||||||
| FirstName: | BRIDGIT | ||||||||
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| Credential: | COTA | ||||||||
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| OtherLastName: | BREKER | ||||||||
| OtherFirstName: | BRIDGIT | ||||||||
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| OtherCredential: | COTA | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 25117 SW PARKWAY AVE | ||||||||
| Address2: | STE D | ||||||||
| City: | WILSONVILLE | ||||||||
| State: | OR | ||||||||
| PostalCode: | 970709697 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9712242040 | ||||||||
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| Practice Location | |||||||||
| Address1: | 150 COUNTY ROAD 34 | ||||||||
| Address2: | |||||||||
| City: | ARTHUR | ||||||||
| State: | ND | ||||||||
| PostalCode: | 580064102 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7019678316 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/15/2015 | ||||||||
| LastUpdateDate: | 10/16/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 224Z00000X | 1310 | ND | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapy Assistant |
No ID Information.