Individual
KARISA BRIDWELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
96102 MARSH LAKES DR, FERNANDINA BEACH, FL 32034-6877
(904) 556-6120
Mailing address
96102 MARSH LAKES DR, FERNANDINA BEACH, FL 32034-6877
(904) 556-6120
Taxonomy
Speciality
Code
Description
License number
State
222Q00000X
Developmental Therapist
—
—
235500000X
Speech/Language/Hearing Specialist/Technologist
Primary
—
—
Other
Enumeration date
05/19/2016
Last updated
05/19/2016
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