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General NPI Number Information
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NPI Number | 1801870290
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Entity Type | Individual
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Provider Name | MRS. CHRISTINA BERRY
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Gender | Female
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Dates
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Enumeration Date | 11/30/2005
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Last Update Date | 10/31/2018
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Provider Practice Location Address
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Address Line | 215 SOUTH ST
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City | SOUTHOLD
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State | NY
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Zip | 11971-1996
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Country | US
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Telephone | 631-765-8084
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Fax | 631-765-8897
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Provider Business Mailing Address
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Address Line | 215 SOUTH ST
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City | SOUTHOLD
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State | NY
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Zip | 11971-1996
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Country | US
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Telephone | 631-765-8084
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Fax | 631-765-0013
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 0128821
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License Number State | NY
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