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NPI Code Detail

MEDICARE: HEATHER BERGENSTEN

MEDICARE: HEATHER BERGENSTEN
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225X00000XOccupational TherapistOC010514PA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2101802OTHERPAFACILITY LICENSE NUMBER

General Provider Information

NPI Number : 1619385242
Entity Type Code : Individual
Provider Name (Legal Business Name) : HEATHER BERGENSTEN
Provider Business Mailing Address
First Line : 1404 GOLF PARK DR
Second Line :
City : LAKE ARIEL
State : PA
Zip : 18436-4252
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1404 GOLF PARK DR
Second Line :
City : LAKE ARIEL
State : PA
Zip : 18436-4252
Country : US
Telephone Number : 570-698-5647
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/28/2014
Last Update Date : 07/28/2014

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Directions to “ HEATHER BERGENSTEN ” Practice Location

Language Start Address Practice Location
These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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