Active NPI
Kimberly D Bergan, MOT, OTR/L
- Occupational Therapist
- Bloomington, IN
National Provider Identifier
1285116657
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapist
- License
- 31001986A
- Practice address
- 3607 S Heirloom Dr
Bloomington, IN 47401 - Phone
- (812) 336-2718
- NPI assigned
- Sep 3, 2018
- 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 | 31001986A | IN | Primary |
Addresses
Primary practice location
3607 S Heirloom Dr
Bloomington, IN 47401
Mailing address
5599 W Redbud Dr
Ellettsville, IN 47429
Phone (812) 320-0098
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)
- Enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1535932800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1535932800000",
"number": "1285116657",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5599 W REDBUD DR",
"city": "ELLETTSVILLE",
"state": "IN",
"postal_code": "47429",
"telephone_number": "812-320-0098"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3607 S HEIRLOOM DR",
"city": "BLOOMINGTON",
"state": "IN",
"postal_code": "47401",
"telephone_number": "812-336-2718"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BERGAN",
"first_name": "KIMBERLY",
"middle_name": "D",
"credential": "MOT, OTR/L",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2018-09-03",
"last_updated": "2018-09-03",
"status": "A"
},
"taxonomies": [
{
"code": "225X00000X",
"taxonomy_group": "",
"desc": "Occupational Therapist",
"state": "IN",
"license": "31001986A",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Bloomington, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 3, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.