Active NPI
Lynn Bergstrom, OT
- Occupational Therapist
- Minneapolis, MN
National Provider Identifier
1912113754
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapist
- License
- 100340
- Practice address
- 3700 Cedar Lake Ave
Minneapolis, MN 55416-4240 - Phone
- (612) 925-7247
- NPI assigned
- May 16, 2007
- Sex
- Female
- Sole proprietor
- No
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 | 100340 | MN | Primary |
Addresses
Primary practice location
3700 Cedar Lake Ave
Minneapolis, MN 55416-4240
Mailing address
3700 Cedar Lake Ave
Minneapolis, MN 55416-4240
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 100340 | Other | MN | OT LICENSE |
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 |
|---|---|---|---|
| 100340 | MN | MD | Occupational Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1179273600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1912113754",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3700 CEDAR LAKE AVE",
"city": "MINNEAPOLIS",
"state": "MN",
"postal_code": "554164240"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3700 CEDAR LAKE AVE",
"city": "MINNEAPOLIS",
"state": "MN",
"postal_code": "554164240",
"telephone_number": "612-925-7247"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BERGSTROM",
"first_name": "LYNN",
"credential": "OT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-05-16",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "225X00000X",
"taxonomy_group": "",
"desc": "Occupational Therapist",
"state": "MN",
"license": "100340",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "OT LICENSE",
"identifier": "100340",
"state": "MN"
}
],
"endpoints": [],
"other_names": []
}Other providers in Minneapolis, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.