MEDICARE: MR. KEVIN BERNER MS OTR/L

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	225X00000X	Occupational Therapist	8989	MA
2	225XN1300X	Neurorehabilitation Occupational Therapist	8989	MA

General Provider Information

NPI Number	:	1871735811
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. KEVIN BERNER MS OTR/L

Provider Business Mailing Address
First Line	:	250 POND ST
Second Line	:
City	:	BRAINTREE
State	:	MA
Zip	:	02184-5351
Country	:	US
Telephone Number	:	781-348-2500
Fax Number	:

Provider Business Practice Location Address
First Line	:	2049 DORCHESTER AVE
Second Line	:
City	:	DORCHESTER CENTER
State	:	MA
Zip	:	02124-4742
Country	:	US
Telephone Number	:	617-825-3905
Fax Number	:

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

Provider Enumeration Date	:	04/06/2009
Last Update Date	:	04/06/2009

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