Basic Information
| Provider Information | |||||||||
| NPI: | 1871735811 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BERNER | ||||||||
| FirstName: | KEVIN | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | MS OTR/L | ||||||||
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| Mailing Information | |||||||||
| Address1: | 250 POND ST | ||||||||
| Address2: | |||||||||
| City: | BRAINTREE | ||||||||
| State: | MA | ||||||||
| PostalCode: | 021845351 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7813482500 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2049 DORCHESTER AVE | ||||||||
| Address2: | |||||||||
| City: | DORCHESTER CENTER | ||||||||
| State: | MA | ||||||||
| PostalCode: | 021244742 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6178253905 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/06/2009 | ||||||||
| LastUpdateDate: | 04/06/2009 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225X00000X | 8989 | MA | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | 225XN1300X | 8989 | MA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | Neurorehabilitation |
No ID Information.