Healthcare Provider Details

I. General information

NPI: 1992615595
Provider Name (Legal Business Name): JESSICA BERNARDINO OT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/08/2026
Last Update Date: 09/08/2026
Certification Date: 09/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

555 COLLEGE DR STE C
HENDERSON NV
89015-1546
US

IV. Provider business mailing address

555 COLLEGE DR STE C
HENDERSON NV
89015-1546
US

V. Phone/Fax

Practice location:
  • Phone: 725-254-1251
  • Fax: 725-254-1252
Mailing address:
  • Phone: 725-254-1251
  • Fax: 725-254-1252

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT-3936
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: