Healthcare Provider Details

I. General information

NPI: 1164348157
Provider Name (Legal Business Name): MICHAELA BERGSMAN OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/25/2026
Last Update Date: 06/25/2026
Certification Date: 06/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

364 SACKMAN ST
BROOKLYN NY
11212-7604
US

IV. Provider business mailing address

501 MARBELLA LN APT 314
SANFORD FL
32771-0174
US

V. Phone/Fax

Practice location:
  • Phone: 718-495-7746
  • Fax:
Mailing address:
  • Phone: 602-486-6227
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number031123
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: