Individual
THERESA LYNN BERGMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
COTA
Contact information
Practice address
515 N MAIN ST, AVILLA, IN 46710-9601
(260) 897-2841
Mailing address
PO BOX 182, AUBURN, IN 46706-0182
(260) 927-5102
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
32002091A
IN
Other
Enumeration date
12/21/2020
Last updated
12/21/2020
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