Provider Demographics
NPI:1124381041
Name:PREMIER STRATEGIES LLC
Entity Type:Organization
Organization Name:PREMIER STRATEGIES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:P
Authorized Official - Last Name:BERRY
Authorized Official - Suffix:
Authorized Official - Credentials:OTR
Authorized Official - Phone:260-385-2130
Mailing Address - Street 1:10620 CORPORATE DR
Mailing Address - Street 2:STE C
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46845-1711
Mailing Address - Country:US
Mailing Address - Phone:260-385-2130
Mailing Address - Fax:260-818-2044
Practice Address - Street 1:10620 CORPORATE DR
Practice Address - Street 2:STE C
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46845-1711
Practice Address - Country:US
Practice Address - Phone:260-385-2130
Practice Address - Fax:260-818-2044
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-18
Last Update Date:2012-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN31000293A225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200628720AMedicaid