Provider Demographics
NPI:1760616361
Name:BERGERON, BETH E (MOT, OT,CHT)
Entity Type:Individual
Prefix:MRS
First Name:BETH
Middle Name:E
Last Name:BERGERON
Suffix:
Gender:F
Credentials:MOT, OT,CHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2317 W UNIVERSITY DR
Mailing Address - Street 2:SUITE A-7
Mailing Address - City:DENTON
Mailing Address - State:TX
Mailing Address - Zip Code:76201-1600
Mailing Address - Country:US
Mailing Address - Phone:940-349-0024
Mailing Address - Fax:940-349-0027
Practice Address - Street 1:2317 W UNIVERSITY DR
Practice Address - Street 2:SUITE A-7
Practice Address - City:DENTON
Practice Address - State:TX
Practice Address - Zip Code:76201-1600
Practice Address - Country:US
Practice Address - Phone:940-349-0024
Practice Address - Fax:940-349-0027
Is Sole Proprietor?:No
Enumeration Date:2009-05-11
Last Update Date:2009-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX108281225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist