Provider Demographics
NPI:1285871384
Name:BERNHARDT, NOREEN ANN (COTA)
Entity type:Individual
Prefix:MRS
First Name:NOREEN
Middle Name:ANN
Last Name:BERNHARDT
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:87 LOWER RESERVOIR RD
Mailing Address - Street 2:
Mailing Address - City:GOSHEN
Mailing Address - State:NY
Mailing Address - Zip Code:10924-6609
Mailing Address - Country:US
Mailing Address - Phone:845-294-1662
Mailing Address - Fax:
Practice Address - Street 1:612 CORPORATE WAY
Practice Address - Street 2:SUITE 3M
Practice Address - City:VALLEY COTTAGE
Practice Address - State:NY
Practice Address - Zip Code:10989-2021
Practice Address - Country:US
Practice Address - Phone:845-268-2323
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-01-11
Last Update Date:2009-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007062-1224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant