Provider Demographics
NPI:1689902942
Name:BERGMAN, NANCY JO (OTR/L)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:JO
Last Name:BERGMAN
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 1:7049 MURILLO LN
Mailing Address - Street 2:
Mailing Address - City:CARLSBAD
Mailing Address - State:CA
Mailing Address - Zip Code:92009-6601
Mailing Address - Country:US
Mailing Address - Phone:760-931-0393
Mailing Address - Fax:760-931-1080
Practice Address - Street 1:2648 MAIN ST
Practice Address - Street 2:SUITE B/C
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91911-4664
Practice Address - Country:US
Practice Address - Phone:619-575-2192
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-11-25
Last Update Date:2013-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOT6783225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist