Provider Demographics
NPI:1811219793
Name:BERRY, NOELLE BETH (OTR)
Entity Type:Individual
Prefix:MRS
First Name:NOELLE
Middle Name:BETH
Last Name:BERRY
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:MISS
Other - First Name:NOELLE
Other - Middle Name:BETH
Other - Last Name:LEWIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR
Mailing Address - Street 1:125 N PARKSIDE DR
Mailing Address - Street 2:SUITE 201
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80909-6097
Mailing Address - Country:US
Mailing Address - Phone:719-785-3748
Mailing Address - Fax:719-785-3798
Practice Address - Street 1:125 N PARKSIDE DR
Practice Address - Street 2:SUITE 201
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80909-6097
Practice Address - Country:US
Practice Address - Phone:719-785-3748
Practice Address - Fax:719-785-3798
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-19
Last Update Date:2010-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1338225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NONEOtherNONE