Provider Demographics
NPI:1750310546
Name:BERRYHILL, JOAN KNEEDLER (OTR/L)
Entity Type:Individual
Prefix:
First Name:JOAN
Middle Name:KNEEDLER
Last Name:BERRYHILL
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:JOAN
Other - Middle Name:G KNEEDLER
Other - Last Name:BERRYHILL
Other - Suffix:II
Other - Last Name Type:Professional Name
Other - Credentials:OTR/L
Mailing Address - Street 1:900 OLDE OAK CT
Mailing Address - Street 2:
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73026-0899
Mailing Address - Country:US
Mailing Address - Phone:405-255-2512
Mailing Address - Fax:
Practice Address - Street 1:900 OLDE OAK CT
Practice Address - Street 2:
Practice Address - City:NORMAN
Practice Address - State:OK
Practice Address - Zip Code:73026-0899
Practice Address - Country:US
Practice Address - Phone:405-255-2512
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-02
Last Update Date:2008-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK386225X00000X, 225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100672620AMedicaid
OK100672620BMedicaid