Provider Demographics
NPI:1306406673
Name:BERKOWICZ, WERONIKA (OTR/L)
Entity Type:Individual
Prefix:
First Name:WERONIKA
Middle Name:
Last Name:BERKOWICZ
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 1:3501 N NEENAH AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60634-3828
Mailing Address - Country:US
Mailing Address - Phone:773-744-1480
Mailing Address - Fax:
Practice Address - Street 1:3501 N NEENAH AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60634-3828
Practice Address - Country:US
Practice Address - Phone:773-744-1480
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-18
Last Update Date:2020-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
056.013079225X00000X
AZOTH-008301225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist