Provider Demographics
NPI:1407017296
Name:BERRY, KRISTINA ANN (COTA)
Entity Type:Individual
Prefix:MRS
First Name:KRISTINA
Middle Name:ANN
Last Name:BERRY
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:MISS
Other - First Name:KRISTINA
Other - Middle Name:ANN
Other - Last Name:DUNAWAY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:COTA
Mailing Address - Street 1:10815 BLUE SKY DR
Mailing Address - Street 2:
Mailing Address - City:MIDWEST CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73130-2121
Mailing Address - Country:US
Mailing Address - Phone:405-708-2947
Mailing Address - Fax:
Practice Address - Street 1:6400 N SANTA FE AVE STE B
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73116-9126
Practice Address - Country:US
Practice Address - Phone:405-840-2903
Practice Address - Fax:405-840-3256
Is Sole Proprietor?:No
Enumeration Date:2008-06-24
Last Update Date:2008-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK763224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant