Provider Demographics
NPI:1982244422
Name:BERGLUND, LAURYN NICOLE (OTD, OTR/L)
Entity Type:Individual
Prefix:
First Name:LAURYN
Middle Name:NICOLE
Last Name:BERGLUND
Suffix:
Gender:F
Credentials:OTD, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 N 46TH ST APT 1409
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68132-3264
Mailing Address - Country:US
Mailing Address - Phone:402-536-9054
Mailing Address - Fax:
Practice Address - Street 1:7200 E QUINCY AVE
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80237-2255
Practice Address - Country:US
Practice Address - Phone:303-221-9611
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-13
Last Update Date:2021-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO6290225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist