Active NPI
Penny Regina Bergeson
- Occupational Therapist
- Milford, MA
National Provider Identifier
1235410002
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapist
- License
- 3693
- Practice address
- 375 Fortune Blvd
Milford, MA 01757-1723 - Phone
- (508) 478-7752
- NPI assigned
- Sep 7, 2011
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Occupational Therapist | 225X00000X | 3693 | MA | Primary |
Addresses
Primary practice location
375 Fortune Blvd
Milford, MA 01757-1723
Mailing address
11 Andrew Dr
Sutton, MA 01590-1808
Phone (508) 865-1336
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 3693 | MA | MD | Occupational Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1315353600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1315353600000",
"number": "1235410002",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "11 ANDREW DR",
"city": "SUTTON",
"state": "MA",
"postal_code": "015901808",
"telephone_number": "508-865-1336"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "375 FORTUNE BLVD",
"city": "MILFORD",
"state": "MA",
"postal_code": "017571723",
"telephone_number": "508-478-7752"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BERGESON",
"first_name": "PENNY",
"middle_name": "REGINA",
"name_prefix": "Mrs.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2011-09-07",
"last_updated": "2011-09-07",
"status": "A"
},
"taxonomies": [
{
"code": "225X00000X",
"taxonomy_group": "",
"desc": "Occupational Therapist",
"state": "MA",
"license": "3693",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Milford, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 7, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.