Individual
BRIDGETT LOREN MIRACLE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
303 SECOND ST, SOMERSET, KY 42501-2390
(606) 677-1166
(606) 677-0693
Mailing address
58 MILL CREEK DR, CORBIN, KY 40701-4182
(606) 677-1166
(606) 677-0693
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
174748
KY
Other
Enumeration date
09/13/2017
Last updated
09/13/2017
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