Provider Demographics
NPI:1184838708
Name:BERG, VALERIE (OTR)
Entity Type:Individual
Prefix:
First Name:VALERIE
Middle Name:
Last Name:BERG
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1802 N TANQUE VERDE LOOP RD
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85749-9777
Mailing Address - Country:US
Mailing Address - Phone:520-444-5694
Mailing Address - Fax:
Practice Address - Street 1:1802 N TANQUE VERDE LOOP RD
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85749-9777
Practice Address - Country:US
Practice Address - Phone:520-444-5694
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-10
Last Update Date:2019-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ2628225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ2628OtherAZ BOARD OF OT LICENSE NO
AZ536831OtherAHCCCS PROVIDER NUMBER