Basic Information
| Provider Information | |||||||||
| NPI: | 1700300381 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BERNARD | ||||||||
| FirstName: | CLAIR | ||||||||
| MiddleName: | GLORIA | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | OTR/L | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | ELROD | ||||||||
| OtherFirstName: | CLAIR | ||||||||
| OtherMiddleName: | GLORIA | ||||||||
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| OtherCredential: | |||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 10145 MOUND SPRING TER | ||||||||
| Address2: | |||||||||
| City: | BLOOMINGTON | ||||||||
| State: | MN | ||||||||
| PostalCode: | 554205133 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9522975973 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 14101 FAIRVIEW DR STE 300 | ||||||||
| Address2: | |||||||||
| City: | BURNSVILLE | ||||||||
| State: | MN | ||||||||
| PostalCode: | 553372537 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9528922650 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/26/2017 | ||||||||
| LastUpdateDate: | 09/24/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225X00000X | 105432 | MN | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist |
No ID Information.