Provider Demographics
NPI:1003685140
Name:BERGERON, KERRIGAN (OTR/L)
Entity Type:Individual
Prefix:MS
First Name:KERRIGAN
Middle Name:
Last Name:BERGERON
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 EMERY RD
Mailing Address - Street 2:
Mailing Address - City:JAFFREY
Mailing Address - State:NH
Mailing Address - Zip Code:03452-5200
Mailing Address - Country:US
Mailing Address - Phone:603-486-8184
Mailing Address - Fax:
Practice Address - Street 1:11 ELM ST
Practice Address - Street 2:
Practice Address - City:PETERBOROUGH
Practice Address - State:NH
Practice Address - Zip Code:03458-1047
Practice Address - Country:US
Practice Address - Phone:603-924-3691
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-01
Last Update Date:2024-01-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH3496225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH3496OtherSTATE OF NEW HAMPSHIRE OFFICE OF LICENSED ALLIED HEALTH PROFESSIONALS