Provider Demographics
NPI:1831846856
Name:BERRY, JACQUELINE B (OTR/L)
Entity type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:B
Last Name:BERRY
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:JACQUELINE
Other - Middle Name:
Other - Last Name:DE LEEF
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1854A HENDERSONVILLE RD # 107
Mailing Address - Street 2:
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28803-2467
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:308 OVERLOOK RD
Practice Address - Street 2:
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28803-3319
Practice Address - Country:US
Practice Address - Phone:828-684-1982
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-09
Last Update Date:2022-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9027225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NONEOtherNONE