Provider Demographics
NPI:1518565712
Name:BEREND, TRISSA
Entity Type:Individual
Prefix:
First Name:TRISSA
Middle Name:
Last Name:BEREND
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2094 WOLF RD
Mailing Address - Street 2:
Mailing Address - City:WINDTHORST
Mailing Address - State:TX
Mailing Address - Zip Code:76389-4635
Mailing Address - Country:US
Mailing Address - Phone:940-733-6623
Mailing Address - Fax:
Practice Address - Street 1:605 W MULBERRY ST
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:TX
Practice Address - Zip Code:76234-1263
Practice Address - Country:US
Practice Address - Phone:940-733-6623
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-12
Last Update Date:2020-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant