Provider Demographics
NPI:1891819702
Name:BERGER, PAMELA (OTR)
Entity Type:Individual
Prefix:MRS
First Name:PAMELA
Middle Name:
Last Name:BERGER
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 DUXBURY RD
Mailing Address - Street 2:
Mailing Address - City:GREAT NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11023-1718
Mailing Address - Country:US
Mailing Address - Phone:516-466-4982
Mailing Address - Fax:516-482-0064
Practice Address - Street 1:21 DUXBURY RD
Practice Address - Street 2:
Practice Address - City:GREAT NECK
Practice Address - State:NY
Practice Address - Zip Code:11023-1718
Practice Address - Country:US
Practice Address - Phone:516-466-4982
Practice Address - Fax:516-482-0064
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004685225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist