Provider Demographics
NPI:1700300381
Name:BERNARD, CLAIR GLORIA (OTR/L)
Entity type:Individual
Prefix:
First Name:CLAIR
Middle Name:GLORIA
Last Name:BERNARD
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:CLAIR
Other - Middle Name:GLORIA
Other - Last Name:ELROD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:10145 MOUND SPRING TER
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:MN
Mailing Address - Zip Code:55420-5133
Mailing Address - Country:US
Mailing Address - Phone:952-297-5973
Mailing Address - Fax:
Practice Address - Street 1:14101 FAIRVIEW DR STE 300
Practice Address - Street 2:
Practice Address - City:BURNSVILLE
Practice Address - State:MN
Practice Address - Zip Code:55337-2537
Practice Address - Country:US
Practice Address - Phone:952-892-2650
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-26
Last Update Date:2019-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN105432225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist