Basic Information
| Provider Information | |||||||||
| NPI: | 1497979728 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BERG | ||||||||
| FirstName: | PAULA | ||||||||
| MiddleName: | TERRY | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | OTR | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9 ALICIA CT | ||||||||
| Address2: | |||||||||
| City: | WEST NYACK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 109941844 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8453532463 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 51-55 NORTH ROUTE 9W | ||||||||
| Address2: | |||||||||
| City: | WEST HAVERSTRAW | ||||||||
| State: | NY | ||||||||
| PostalCode: | 10993 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8457864358 | ||||||||
| FaxNumber: | 8457864022 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/11/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225X00000X | 002228-1 | NY | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist |
No ID Information.