Provider Demographics
NPI:1013680776
Name:BERRIN, KIERA ELIZABETH
Entity Type:Individual
Prefix:
First Name:KIERA
Middle Name:ELIZABETH
Last Name:BERRIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 GRANT AVE E
Mailing Address - Street 2:
Mailing Address - City:BABYLON
Mailing Address - State:NY
Mailing Address - Zip Code:11702-4206
Mailing Address - Country:US
Mailing Address - Phone:631-792-4055
Mailing Address - Fax:
Practice Address - Street 1:16 GRANT AVE E
Practice Address - Street 2:
Practice Address - City:BABYLON
Practice Address - State:NY
Practice Address - Zip Code:11702-4206
Practice Address - Country:US
Practice Address - Phone:631-792-4055
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-28
Last Update Date:2021-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY025800225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty