Provider Demographics
NPI:1093050080
Name:BERRY, MONICA SNIPES (OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:MONICA
Middle Name:SNIPES
Last Name:BERRY
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1543 BETHEA EXT
Mailing Address - Street 2:
Mailing Address - City:LATTA
Mailing Address - State:SC
Mailing Address - Zip Code:29565-4009
Mailing Address - Country:US
Mailing Address - Phone:843-752-0763
Mailing Address - Fax:
Practice Address - Street 1:1543 BETHEA EXT
Practice Address - Street 2:
Practice Address - City:LATTA
Practice Address - State:SC
Practice Address - Zip Code:29565-4009
Practice Address - Country:US
Practice Address - Phone:843-752-0763
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-03
Last Update Date:2012-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2558225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist