Provider Demographics
NPI:1093376055
Name:WHALEY, BERTHA ANN (OTR/L)
Entity Type:Individual
Prefix:MS
First Name:BERTHA
Middle Name:ANN
Last Name:WHALEY
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 1:1031 CASCADE CIR APT 304
Mailing Address - Street 2:
Mailing Address - City:ROCKLEDGE
Mailing Address - State:FL
Mailing Address - Zip Code:32955-8080
Mailing Address - Country:US
Mailing Address - Phone:786-287-0175
Mailing Address - Fax:
Practice Address - Street 1:1031 CASCADE CIR APT 304
Practice Address - Street 2:
Practice Address - City:ROCKLEDGE
Practice Address - State:FL
Practice Address - Zip Code:32955-8080
Practice Address - Country:US
Practice Address - Phone:786-287-0175
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-21
Last Update Date:2019-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL6333225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist