Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225XG0600X | Occupational Therapist - Gerontology | 40TR00289300 | NJ |
Y | 225XP0019X | Occupational Therapist - Physical Rehabilitation | 40TR00289300 | NJ |
NPI | 1144627001 |
---|---|
Provider Name | Suzanne L Berkheiser |
First Address | Whiting, NJ 08759-2912 |
Second Address | Whiting, NJ 08759-2912 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/11/2014 |
Last Update Date | 20/11/2014 |