Provider Demographics
NPI:1174353171
Name:BERNHARDT, MADELYN (OTD, OTR/L)
Entity type:Individual
Prefix:
First Name:MADELYN
Middle Name:
Last Name:BERNHARDT
Suffix:
Gender:F
Credentials:OTD, OTR/L
Other - Prefix:
Other - First Name:MADDIE
Other - Middle Name:
Other - Last Name:BERNHARDT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:3488 JEFFCO BLVD STE 102
Mailing Address - Street 2:
Mailing Address - City:ARNOLD
Mailing Address - State:MO
Mailing Address - Zip Code:63010-6015
Mailing Address - Country:US
Mailing Address - Phone:636-464-5439
Mailing Address - Fax:636-464-5438
Practice Address - Street 1:3488 JEFFCO BLVD STE 102
Practice Address - Street 2:
Practice Address - City:ARNOLD
Practice Address - State:MO
Practice Address - Zip Code:63010-6015
Practice Address - Country:US
Practice Address - Phone:636-464-5439
Practice Address - Fax:636-464-5438
Is Sole Proprietor?:No
Enumeration Date:2024-08-05
Last Update Date:2024-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225X00000X
MO2024027234225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist