Provider Demographics
NPI:1801870290
Name:BERRY, CHRISTINA
Entity type:Individual
Prefix:MRS
First Name:CHRISTINA
Middle Name:
Last Name:BERRY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:CHRISTINA
Other - Middle Name:
Other - Last Name:BERRY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MS OTR/L
Mailing Address - Street 1:215 SOUTH ST
Mailing Address - Street 2:
Mailing Address - City:SOUTHOLD
Mailing Address - State:NY
Mailing Address - Zip Code:11971-1996
Mailing Address - Country:US
Mailing Address - Phone:631-765-8084
Mailing Address - Fax:631-765-0013
Practice Address - Street 1:215 SOUTH ST
Practice Address - Street 2:
Practice Address - City:SOUTHOLD
Practice Address - State:NY
Practice Address - Zip Code:11971-1996
Practice Address - Country:US
Practice Address - Phone:631-765-8084
Practice Address - Fax:631-765-8897
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-30
Last Update Date:2018-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0128821225X00000X, 225XE1200X, 225XN1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Not Answered225XE1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistErgonomics
Not Answered225XN1300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistNeurorehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY11518456OtherCAQH
NY2034188811OtherTAX ID
NY0128821OtherLICENSE
NYQU1131Medicare ID - Type Unspecified