Provider Demographics
NPI:1205231826
Name:BERNARD, KRISTY (OTD, OTR/L)
Entity Type:Individual
Prefix:
First Name:KRISTY
Middle Name:
Last Name:BERNARD
Suffix:
Gender:F
Credentials:OTD, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2500 MEDARY AVE
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43202-2643
Mailing Address - Country:US
Mailing Address - Phone:614-262-7520
Mailing Address - Fax:614-262-7540
Practice Address - Street 1:2500 MEDARY AVE
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43202-2643
Practice Address - Country:US
Practice Address - Phone:614-262-7520
Practice Address - Fax:614-262-7540
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-24
Last Update Date:2014-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH008431225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics