Basic Information
| Provider Information | |||||||||
| NPI: | 1487905147 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | BERDIN | ||||||||
| FirstName: | JONAH ALNE CRISTIE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3330 LAKE CENTER DR APT 15106 | ||||||||
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| City: | MOUNT DORA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 327572374 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5053991487 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3290 N RIDGE RD STE 290 | ||||||||
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| City: | ELLICOTT CITY | ||||||||
| State: | MD | ||||||||
| PostalCode: | 210433657 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4107509006 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/20/2012 | ||||||||
| LastUpdateDate: | 09/20/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225X00000X | 14095 | FL | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist |
No ID Information.