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General NPI Number Information
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NPI Number | 1295039311
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Entity Type | Individual
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Provider Name | HEATHER BERGLUND OTR
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Gender | Female
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Dates
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Enumeration Date | 01/04/2011
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Last Update Date | 01/18/2013
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Provider Practice Location Address
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Address Line | 1519 60TH ST
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City | KENOSHA
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State | WI
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Zip | 53140-3954
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Country | US
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Telephone | 262-656-7500
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Fax |
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Provider Business Mailing Address
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Address Line | 8551 VENTANA DR UNIT 4423
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City | OAK CREEK
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State | WI
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Zip | 53154-8342
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Country | US
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Telephone | 701-650-0226
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 4884-026
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License Number State | WI
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