Provider Demographics
NPI:1265561617
Name:TRIVINIA, BRIDGET A (MSOTRL)
Entity type:Individual
Prefix:
First Name:BRIDGET
Middle Name:A
Last Name:TRIVINIA
Suffix:
Gender:F
Credentials:MSOTRL
Other - Prefix:
Other - First Name:BRIDGET
Other - Middle Name:A
Other - Last Name:GETTS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSOTRL
Mailing Address - Street 1:331 TILTON RD
Mailing Address - Street 2:STE 7
Mailing Address - City:NORTHFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:08225-1201
Mailing Address - Country:US
Mailing Address - Phone:877-407-3422
Mailing Address - Fax:877-407-4329
Practice Address - Street 1:801 KINGS HWY N
Practice Address - Street 2:FOX REHABILITATION SERVICES
Practice Address - City:CHERRY HILL
Practice Address - State:NJ
Practice Address - Zip Code:08034-1513
Practice Address - Country:US
Practice Address - Phone:877-407-3422
Practice Address - Fax:877-407-4329
Is Sole Proprietor?:No
Enumeration Date:2007-03-03
Last Update Date:2017-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ46TR00265700225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ083018PCVMedicare ID - Type UnspecifiedPROVIDER NUMBER