Provider Demographics
NPI:1689217184
Name:BERNARD, DONNA CHARM (OT)
Entity Type:Individual
Prefix:
First Name:DONNA
Middle Name:CHARM
Last Name:BERNARD
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 1:9 BROWNSTONE WAY APT 505
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07631-1218
Mailing Address - Country:US
Mailing Address - Phone:201-390-5259
Mailing Address - Fax:
Practice Address - Street 1:9 BROWNSTONE WAY APT 505
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07631-1218
Practice Address - Country:US
Practice Address - Phone:201-390-5259
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-28
Last Update Date:2019-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ46TR00199100225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist