Provider Demographics
NPI:1528396249
Name:BERGANTINOS, DOHA QATRINA PASCUAL (OTR/L,)
Entity Type:Individual
Prefix:MS
First Name:DOHA QATRINA
Middle Name:PASCUAL
Last Name:BERGANTINOS
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 1:8613 N MILWAUKEE AVE APT 1W
Mailing Address - Street 2:
Mailing Address - City:NILES
Mailing Address - State:IL
Mailing Address - Zip Code:60714-1965
Mailing Address - Country:US
Mailing Address - Phone:352-200-9811
Mailing Address - Fax:
Practice Address - Street 1:8613 N MILWAUKEE AVE APT 1W
Practice Address - Street 2:
Practice Address - City:NILES
Practice Address - State:IL
Practice Address - Zip Code:60714-1965
Practice Address - Country:US
Practice Address - Phone:352-200-9811
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-11-19
Last Update Date:2022-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL056008870225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist