Provider Demographics
NPI:1578177986
Name:BERG, BRETT (PHD, OTR/L)
Entity Type:Individual
Prefix:
First Name:BRETT
Middle Name:
Last Name:BERG
Suffix:
Gender:M
Credentials:PHD, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:909 CANYON CT
Mailing Address - Street 2:
Mailing Address - City:WINDSOR
Mailing Address - State:CO
Mailing Address - Zip Code:80550-5355
Mailing Address - Country:US
Mailing Address - Phone:970-492-5416
Mailing Address - Fax:
Practice Address - Street 1:2350 LIMON DR # D12
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80525-7622
Practice Address - Country:US
Practice Address - Phone:970-204-4331
Practice Address - Fax:970-204-6712
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-02
Last Update Date:2020-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2121225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist