MEDICARE: MS. ROXANE MARIE BERENBEIM OTR/R, RN

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	OT7536	CA

General Provider Information

NPI Number	:	1992725154
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. ROXANE MARIE BERENBEIM OTR/R, RN

Provider Business Mailing Address
First Line	:	20 OAK CANYON TRL
Second Line	:
City	:	COTO DE CAZA
State	:	CA
Zip	:	92679-4915
Country	:	US
Telephone Number	:	949-842-7562
Fax Number	:

Provider Business Practice Location Address
First Line	:	631 S BROOKHURST ST
Second Line	:	#106
City	:	ANAHEIM
State	:	CA
Zip	:	92804-3510
Country	:	US
Telephone Number	:	714-490-7711
Fax Number	:

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

Provider Enumeration Date	:	07/20/2006
Last Update Date	:	07/08/2007

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