Healthcare Provider Details

I. General information

NPI: 1760616361
Provider Name (Legal Business Name): BETH E BERGERON OTR, CHT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/11/2009
Last Update Date: 01/09/2025
Certification Date: 01/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

521 PARADISE CV
DENTON TX
76208-5139
US

IV. Provider business mailing address

521 PARADISE CV
DENTON TX
76208-5139
US

V. Phone/Fax

Practice location:
  • Phone: 972-740-2194
  • Fax:
Mailing address:
  • Phone: 972-740-2194
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XH1200X
TaxonomyHand Occupational Therapist
License Number108281
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: