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General NPI Number Information
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NPI Number | 1639159338
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Entity Type | Individual
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Provider Name | MARY LYNN BERNTSON OTRL CHT
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Gender | Female
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Dates
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Enumeration Date | 01/19/2006
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Last Update Date | 07/01/2024
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Provider Practice Location Address
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Address Line | 3035 DEMERS AVE
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City | GRAND FORKS
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State | ND
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Zip | 58201-4040
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Country | US
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Telephone | 701-746-7521
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 5074
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City | SIOUX FALLS
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State | SD
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Zip | 57117-5074
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Country | US
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Telephone | 701-732-2947
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Fax | 701-732-2945
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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 | 100966
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License Number State | MN
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Taxonomy #2
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | AA522599
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License Number State |
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Taxonomy #3
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 25
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License Number State | ND
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