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General NPI Number Information
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NPI Number | 1124381041
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Entity Type | Organization
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Legal Business Name | PREMIER STRATEGIES LLC
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Dates
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Enumeration Date | 06/18/2012
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Last Update Date | 06/18/2012
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Provider Practice Location Address
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Address Line | 10620 CORPORATE DR STE C
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City | FORT WAYNE
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State | IN
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Zip | 46845-1711
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Country | US
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Telephone | 260-385-2130
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Fax | 260-818-2044
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Provider Business Mailing Address
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Address Line | 10620 CORPORATE DR STE C
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City | FORT WAYNE
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State | IN
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Zip | 46845-1711
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Country | US
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Telephone | 260-385-2130
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Fax | 260-818-2044
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Authorized Official
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Title or Position | OWNER/PROVIDER
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Name | MRS. MICHELLE P. BERRY
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Credential | OTR
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Telephone | 260-385-2130
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 31000293A
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License Number State | IN
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