Healthcare Provider Details

I. General information

NPI: 1013870252
Provider Name (Legal Business Name): JOLANA LYNN BERNHARDT OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/04/2025
Last Update Date: 12/04/2025
Certification Date: 12/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1250 W BROADWAY AVE
MINNEAPOLIS MN
55411-2533
US

IV. Provider business mailing address

725 COLUMBIA PKWY
MINNEAPOLIS MN
55418-1251
US

V. Phone/Fax

Practice location:
  • Phone: 612-987-4259
  • Fax: 612-668-5100
Mailing address:
  • Phone: 612-703-2102
  • Fax: 612-668-5100

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number102440
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: