Healthcare Provider Details

I. General information

NPI: 1952007023
Provider Name (Legal Business Name): KIMBERLY ANNE BERNATO CPO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/01/2023
Last Update Date: 02/01/2023
Certification Date: 02/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10701 EAST BLVD
CLEVELAND OH
44106-1702
US

IV. Provider business mailing address

1390 DOCK RD
MADISON OH
44057-2218
US

V. Phone/Fax

Practice location:
  • Phone: 216-791-3800
  • Fax: 216-229-2740
Mailing address:
  • Phone: 330-907-0745
  • Fax: 216-229-2740

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code222Z00000X
TaxonomyOrthotist
License NumberCPO03734
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code224P00000X
TaxonomyProsthetist
License NumberCPO03734
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: