Provider Demographics
NPI:1376855478
Name:BERGMANN, STEPHANIE KATHLEEN (OTR/L)
Entity type:Individual
Prefix:MRS
First Name:STEPHANIE
Middle Name:KATHLEEN
Last Name:BERGMANN
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 1:3740 SOMERSET LN
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76109-3555
Mailing Address - Country:US
Mailing Address - Phone:817-797-7898
Mailing Address - Fax:
Practice Address - Street 1:5417 ALTAMESA BLVD
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76123-2804
Practice Address - Country:US
Practice Address - Phone:817-797-7898
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-06
Last Update Date:2016-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX107628225X00000X
IL056008410225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist