Provider Demographics
NPI:1295039311
Name:BERGLUND, HEATHER (OTR)
Entity Type:Individual
Prefix:MRS
First Name:HEATHER
Middle Name:
Last Name:BERGLUND
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8551 VENTANA DR UNIT 4423
Mailing Address - Street 2:
Mailing Address - City:OAK CREEK
Mailing Address - State:WI
Mailing Address - Zip Code:53154-8342
Mailing Address - Country:US
Mailing Address - Phone:701-650-0226
Mailing Address - Fax:
Practice Address - Street 1:1519 60TH ST
Practice Address - Street 2:
Practice Address - City:KENOSHA
Practice Address - State:WI
Practice Address - Zip Code:53140-3954
Practice Address - Country:US
Practice Address - Phone:262-656-7500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-04
Last Update Date:2013-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4884-026225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist