Individual
NICOLE RENEE BERGSTROM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OTR
Contact information
Practice address
2009 NORTHWOOD DR, SALISBURY, MD 21801-7800
(410) 603-5884
Mailing address
169 CHAPEL BRANCH DR, HEBRON, MD 21830-1067
(443) 260-0942
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
04523
MD
Other
Enumeration date
06/14/2007
Last updated
07/08/2007
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