Provider Demographics
NPI:1073631370
Name:BERG, CATHY ANNE (COTA)
Entity Type:Individual
Prefix:MISS
First Name:CATHY
Middle Name:ANNE
Last Name:BERG
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:MRS
Other - First Name:CATHY
Other - Middle Name:ANNE
Other - Last Name:BERG SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:117 TYLERS COVE WAY
Mailing Address - Street 2:
Mailing Address - City:WINNABOW
Mailing Address - State:NC
Mailing Address - Zip Code:28479-5183
Mailing Address - Country:US
Mailing Address - Phone:910-617-1396
Mailing Address - Fax:
Practice Address - Street 1:1011 PORTERS NECK RD
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28411-9196
Practice Address - Country:US
Practice Address - Phone:910-686-7195
Practice Address - Fax:910-686-7591
Is Sole Proprietor?:No
Enumeration Date:2007-03-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC6182224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant