Healthcare Provider Details

I. General information

NPI: 1710559505
Provider Name (Legal Business Name): SHEMIEKA BERRY OT/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/12/2021
Last Update Date: 07/12/2021
Certification Date: 07/06/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2881 COUNTY ROAD 7714
TROY AL
36081-8624
US

IV. Provider business mailing address

2881 COUNTY ROAD 7714
TROY AL
36081-8624
US

V. Phone/Fax

Practice location:
  • Phone: 334-312-0749
  • Fax:
Mailing address:
  • Phone: 334-312-0749
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number2599
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code225XG0600X
TaxonomyGerontology Occupational Therapist
License Number2599
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: