Provider Demographics
NPI:1437147774
Name:BERKA, ANNETTE M (OT)
Entity Type:Individual
Prefix:MRS
First Name:ANNETTE
Middle Name:M
Last Name:BERKA
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:ANNETTE
Other - Middle Name:M
Other - Last Name:BERUIER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OT
Mailing Address - Street 1:PO BOX 29870
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85038-9870
Mailing Address - Country:US
Mailing Address - Phone:602-772-3800
Mailing Address - Fax:602-772-3801
Practice Address - Street 1:5757 W THUNDERBIRD RD
Practice Address - Street 2:SUITE 465
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85306-4641
Practice Address - Country:US
Practice Address - Phone:602-843-9945
Practice Address - Fax:602-843-8775
Is Sole Proprietor?:No
Enumeration Date:2005-10-11
Last Update Date:2013-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ0042225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ096025Medicaid
AZZ113264OtherMEDICARE GROUP
AZ1508071119Medicare NSC
AZ1396819546Medicare NSC
AZ29293Medicare ID - Type Unspecified
AZ096025Medicaid
AZZ113264OtherMEDICARE GROUP
S89343Medicare UPIN
AZ113185Medicare ID - Type Unspecified205881475