Provider Demographics
NPI:1790060085
Name:BERGMAN, LYNN DENISE (OTR)
Entity Type:Individual
Prefix:MS
First Name:LYNN
Middle Name:DENISE
Last Name:BERGMAN
Suffix:
Gender:F
Credentials:OTR
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Mailing Address - Street 1:201 SUNRISE HIGHWAY
Mailing Address - Street 2:EASTERN SUFFOLK BOCES
Mailing Address - City:PATCHOGUE
Mailing Address - State:NY
Mailing Address - Zip Code:11772
Mailing Address - Country:US
Mailing Address - Phone:631-289-2200
Mailing Address - Fax:631-289-2381
Practice Address - Street 1:15 ANDREA ROAD
Practice Address - Street 2:EASTERN SUFFOLK BOCES - SHERWOOD CORPORATE CENTER
Practice Address - City:HOLBROOK
Practice Address - State:NY
Practice Address - Zip Code:11741
Practice Address - Country:US
Practice Address - Phone:631-218-4181
Practice Address - Fax:631-218-4118
Is Sole Proprietor?:No
Enumeration Date:2011-10-18
Last Update Date:2011-10-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY003767-1225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist