Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225XG0600X | Occupational Therapist - Gerontology | 2599 | AL |
Y | 225XP0200X | Occupational Therapist - Pediatrics | 2599 | AL |
NPI | 1710559505 |
---|---|
Provider Name | Shemieka Berry |
First Address | Troy, AL 36081-8624 |
Second Address | Troy, AL 36081-8624 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/07/2021 |
Last Update Date | 12/07/2021 |