MEDICARE: MS. CAROL ANN BERG

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
1	224Z00000X	Occupational Therapy Assistant	OTA10189	FL

General Provider Information

NPI Number	:	1063644177
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. CAROL ANN BERG

Provider Business Mailing Address
First Line	:	3822 OSPREY POINTE CIR
Second Line	:
City	:	WINTER HAVEN
State	:	FL
Zip	:	33884-2590
Country	:	US
Telephone Number	:	863-258-2634
Fax Number	:

Provider Business Practice Location Address
First Line	:	3822 OSPREY POINTE CIR
Second Line	:
City	:	WINTER HAVEN
State	:	FL
Zip	:	33884-2590
Country	:	US
Telephone Number	:	863-258-2634
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/23/2009
Last Update Date	:	08/23/2009

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