Basic Information
| Provider Information | |||||||||
| NPI: | 1093349722 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BERNAL | ||||||||
| FirstName: | KATHERINE | ||||||||
| MiddleName: | JANICE | ||||||||
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| Credential: | MSOT, OTR/L | ||||||||
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| Mailing Information | |||||||||
| Address1: | 53 COMMONWEALTH AVE | ||||||||
| Address2: | |||||||||
| City: | PITTSFIELD | ||||||||
| State: | MA | ||||||||
| PostalCode: | 012017011 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 435 4TH ST | ||||||||
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| City: | TROY | ||||||||
| State: | NY | ||||||||
| PostalCode: | 121805324 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5182716777 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/03/2020 | ||||||||
| LastUpdateDate: | 07/08/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/08/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225X00000X | 024781 | NY | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist |
No ID Information.