Provider Demographics
NPI:1467881953
Name:BERARDI, MARY BETH (DOT)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:BETH
Last Name:BERARDI
Suffix:
Gender:F
Credentials:DOT
Other - Prefix:MRS
Other - First Name:MARY
Other - Middle Name:BETH
Other - Last Name:THOMAS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:620 TENNIS AVE
Mailing Address - Street 2:
Mailing Address - City:GLENSIDE
Mailing Address - State:PA
Mailing Address - Zip Code:19038-1705
Mailing Address - Country:US
Mailing Address - Phone:215-341-1269
Mailing Address - Fax:
Practice Address - Street 1:620 TENNIS AVE
Practice Address - Street 2:
Practice Address - City:GLENSIDE
Practice Address - State:PA
Practice Address - Zip Code:19038-1705
Practice Address - Country:US
Practice Address - Phone:215-341-1269
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-05
Last Update Date:2013-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOC007145L225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics