Provider Demographics
NPI:1871958850
Name:BERGANTINO, EVE (OTRL)
Entity type:Individual
Prefix:
First Name:EVE
Middle Name:
Last Name:BERGANTINO
Suffix:
Gender:F
Credentials:OTRL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5102 TEATHER ST
Mailing Address - Street 2:
Mailing Address - City:SPRING HILL
Mailing Address - State:FL
Mailing Address - Zip Code:34608-2946
Mailing Address - Country:US
Mailing Address - Phone:352-442-8671
Mailing Address - Fax:
Practice Address - Street 1:5102 TEATHER ST
Practice Address - Street 2:
Practice Address - City:SPRING HILL
Practice Address - State:FL
Practice Address - Zip Code:34608-2946
Practice Address - Country:US
Practice Address - Phone:352-442-8671
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-12-17
Last Update Date:2015-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT5215225XG0600X
MA11816225XG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XG0600XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGerontology