Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225X00000X | Occupational Therapist | 8989 | MA |
Y | 225XN1300X | Occupational Therapist - Neurorehabilitation | 8989 | MA |
NPI | 1871735811 |
---|---|
Provider Name | Mr. Kevin Berner |
First Address | Braintree, MA 02184-5351 |
Second Address | Dorchester Center, MA 02124-4742 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/04/2009 |
Last Update Date | 06/04/2009 |