Provider Demographics
NPI:1215389598
Name:BERGSTEN, KAYLEE ELYSE (OTR/L)
Entity Type:Individual
Prefix:
First Name:KAYLEE
Middle Name:ELYSE
Last Name:BERGSTEN
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 1:840 EMERSON GARDENS RD
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:02420-2615
Mailing Address - Country:US
Mailing Address - Phone:781-861-8630
Mailing Address - Fax:781-861-1099
Practice Address - Street 1:840 EMERSON GARDENS RD
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:MA
Practice Address - Zip Code:02420-2615
Practice Address - Country:US
Practice Address - Phone:781-861-8630
Practice Address - Fax:781-861-1099
Is Sole Proprietor?:No
Enumeration Date:2016-07-11
Last Update Date:2016-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA356581225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist