Provider Demographics
NPI:1376508853
Name:BERGERON, DONNA J (MSH ORTL CHT)
Entity Type:Individual
Prefix:MRS
First Name:DONNA
Middle Name:J
Last Name:BERGERON
Suffix:
Gender:F
Credentials:MSH ORTL CHT
Other - Prefix:MS
Other - First Name:DONNA
Other - Middle Name:J
Other - Last Name:REIST
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR/L
Mailing Address - Street 1:4008 GASTER AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89081-6696
Mailing Address - Country:US
Mailing Address - Phone:702-704-4440
Mailing Address - Fax:
Practice Address - Street 1:4008 GASTER AVE
Practice Address - Street 2:
Practice Address - City:NORTH LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89081-6696
Practice Address - Country:US
Practice Address - Phone:702-704-4440
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-19
Last Update Date:2013-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT1707225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand