Provider Demographics
NPI:1407909195
Name:BERGSOHN, CLAUDIA (OT)
Entity Type:Individual
Prefix:
First Name:CLAUDIA
Middle Name:
Last Name:BERGSOHN
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9717 INDIAN SCHOOL RD NE
Mailing Address - Street 2:EUBANK ES
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87112-2956
Mailing Address - Country:US
Mailing Address - Phone:505-299-4483
Mailing Address - Fax:
Practice Address - Street 1:9717 INDIAN SCHOOL RD NE
Practice Address - Street 2:EUBANK ES
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87112-2956
Practice Address - Country:US
Practice Address - Phone:505-299-4483
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-18
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM2178225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM93626576Medicaid