Provider Demographics
NPI:1861821126
Name:BERBERICH, SUSAN L (COTA/L)
Entity Type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:L
Last Name:BERBERICH
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:MS
Other - First Name:SUSAN
Other - Middle Name:L
Other - Last Name:PINTAGRO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:COTA/L
Mailing Address - Street 1:641 HADCOCK RD
Mailing Address - Street 2:
Mailing Address - City:BRUNSWICK
Mailing Address - State:OH
Mailing Address - Zip Code:44212-2129
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:570 N ROCKY RIVER DR
Practice Address - Street 2:
Practice Address - City:BEREA
Practice Address - State:OH
Practice Address - Zip Code:44017-1613
Practice Address - Country:US
Practice Address - Phone:440-243-2122
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-11-07
Last Update Date:2013-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOTA.04782171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor