Provider Demographics
NPI:1700029543
Name:BERGER, JUDITH LYNN (MS, OTR)
Entity Type:Individual
Prefix:MRS
First Name:JUDITH
Middle Name:LYNN
Last Name:BERGER
Suffix:
Gender:F
Credentials:MS, OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6900 GRAY RD
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46237-3209
Mailing Address - Country:US
Mailing Address - Phone:317-788-2500
Mailing Address - Fax:260-432-9318
Practice Address - Street 1:1400 W FRANKLIN ST
Practice Address - Street 2:
Practice Address - City:ELKHART
Practice Address - State:IN
Practice Address - Zip Code:46516-2044
Practice Address - Country:US
Practice Address - Phone:574-522-2020
Practice Address - Fax:574-522-7820
Is Sole Proprietor?:No
Enumeration Date:2009-04-09
Last Update Date:2010-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN31003670A225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist