Provider Demographics
NPI:1235947185
Name:REUSS, BRIDGET JAE (OTR)
Entity type:Individual
Prefix:
First Name:BRIDGET
Middle Name:JAE
Last Name:REUSS
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:MN
Mailing Address - Zip Code:55313-1569
Mailing Address - Country:US
Mailing Address - Phone:922-955-2242
Mailing Address - Fax:952-955-2010
Practice Address - Street 1:500 PETERSON PKWY
Practice Address - Street 2:
Practice Address - City:NEW LONDON
Practice Address - State:MN
Practice Address - Zip Code:56273-7838
Practice Address - Country:US
Practice Address - Phone:952-955-2242
Practice Address - Fax:952-955-2010
Is Sole Proprietor?:No
Enumeration Date:2024-12-24
Last Update Date:2024-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN107308225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist