Provider Demographics
NPI:1710559505
Name:BERRY, SHEMIEKA (OT/L)
Entity Type:Individual
Prefix:
First Name:SHEMIEKA
Middle Name:
Last Name:BERRY
Suffix:
Gender:F
Credentials:OT/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2881 COUNTY ROAD 7714
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:AL
Mailing Address - Zip Code:36081-8624
Mailing Address - Country:US
Mailing Address - Phone:334-312-0749
Mailing Address - Fax:
Practice Address - Street 1:2881 COUNTY ROAD 7714
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:AL
Practice Address - Zip Code:36081-8624
Practice Address - Country:US
Practice Address - Phone:334-312-0749
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-12
Last Update Date:2021-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL2599225XG0600X, 225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
No225XG0600XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGerontology