=====================================================
General NPI Number Information
=====================================================
NPI Number | 1528574852
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SARA BERKLEY
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/22/2017
-----------------------------------------------------
Last Update Date | 12/22/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 225 16TH ST S
-----------------------------------------------------
City | IRONDALE
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 35210-1647
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 205-379-4200
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 892 VALLEY CIR
-----------------------------------------------------
City | LEEDS
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 35094-2408
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 404-307-3990
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225X00000X
-----------------------------------------------------
Taxonomy Name | Occupational Therapist
-----------------------------------------------------
License Number | 3006
-----------------------------------------------------
License Number State | AL
-----------------------------------------------------