Provider Demographics
NPI:1235460940
Name:BERWICK, ANGELA (OT)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:
Last Name:BERWICK
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1940 N PROSPECT AVE
Mailing Address - Street 2:APT. #31
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53202-1493
Mailing Address - Country:US
Mailing Address - Phone:920-229-0728
Mailing Address - Fax:
Practice Address - Street 1:8390 E CRESCENT PKWY
Practice Address - Street 2:SUITE 120
Practice Address - City:GREENWOOD VILLAGE
Practice Address - State:CO
Practice Address - Zip Code:80111-2811
Practice Address - Country:US
Practice Address - Phone:262-502-8689
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-01-20
Last Update Date:2013-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4817-26225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist