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NPI Code Detail

MEDICARE: MISS BERKELEY R RUSS COTA/L

MEDICARE: MISS BERKELEY R RUSS COTA/L
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1224Z00000XOccupational Therapy Assistant856NE

General Provider Information

NPI Number : 1003180472
Entity Type Code : Individual
Provider Name (Legal Business Name) : MISS BERKELEY R RUSS COTA/L
Provider Business Mailing Address
First Line : 4523 PRESCOTT AVE APT 4
Second Line :
City : LINCOLN
State : NE
Zip : 68506-4964
Country : US
Telephone Number : 320-226-4591
Fax Number :
Provider Business Practice Location Address
First Line : 1133 N 3RD ST
Second Line :
City : TECUMSEH
State : NE
Zip : 68450-2069
Country : US
Telephone Number : 402-335-3357
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/02/2012
Last Update Date : 03/02/2012

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Directions to “ MISS BERKELEY R RUSS COTA/L” Practice Location

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