Provider Demographics
NPI:1275199440
Name:BERGMEIER, DEAN H (COTA/L)
Entity Type:Individual
Prefix:
First Name:DEAN
Middle Name:H
Last Name:BERGMEIER
Suffix:
Gender:M
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:747 S 2ND ST
Mailing Address - Street 2:
Mailing Address - City:SALINA
Mailing Address - State:KS
Mailing Address - Zip Code:67401-4901
Mailing Address - Country:US
Mailing Address - Phone:785-643-1698
Mailing Address - Fax:
Practice Address - Street 1:500 SW 42ND ST
Practice Address - Street 2:
Practice Address - City:TOPEKA
Practice Address - State:KS
Practice Address - Zip Code:66609-1241
Practice Address - Country:US
Practice Address - Phone:785-643-1698
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-14
Last Update Date:2019-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS369568224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS1801417OtherKANSAS BOARD OF HEALING ARTS