Provider Demographics
NPI:1346424595
Name:JOACHIN, BERTHIDE (COTA/L)
Entity Type:Individual
Prefix:MS
First Name:BERTHIDE
Middle Name:
Last Name:JOACHIN
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4375 N MAJOR DR APT 1811
Mailing Address - Street 2:
Mailing Address - City:BEAUMONT
Mailing Address - State:TX
Mailing Address - Zip Code:77713-9556
Mailing Address - Country:US
Mailing Address - Phone:954-778-9110
Mailing Address - Fax:
Practice Address - Street 1:4375 N MAJOR DR APT 1811
Practice Address - Street 2:
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77713-9556
Practice Address - Country:US
Practice Address - Phone:954-778-9110
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-12-24
Last Update Date:2018-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOTA10430224Z00000X
TX213036224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant