Provider Demographics
NPI:1871670224
Name:BERRY, TONI C (COTA/L)
Entity Type:Individual
Prefix:MS
First Name:TONI
Middle Name:C
Last Name:BERRY
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:396 ELEMENTARY DR
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28301-6267
Mailing Address - Country:US
Mailing Address - Phone:910-678-2789
Mailing Address - Fax:910-678-2793
Practice Address - Street 1:396 ELEMENTARY DR
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28301-6267
Practice Address - Country:US
Practice Address - Phone:910-678-2789
Practice Address - Fax:910-678-2793
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4787224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant