Provider Demographics
NPI:1841486677
Name:BERDIS, JUDITH ANN (OT/L)
Entity type:Individual
Prefix:
First Name:JUDITH
Middle Name:ANN
Last Name:BERDIS
Suffix:
Gender:F
Credentials:OT/L
Other - Prefix:
Other - First Name:JUDI
Other - Middle Name:
Other - Last Name:BERDIS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OT/L
Mailing Address - Street 1:245 REDWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:WILLITS
Mailing Address - State:CA
Mailing Address - Zip Code:95490-3429
Mailing Address - Country:US
Mailing Address - Phone:707-459-4444
Mailing Address - Fax:707-459-1444
Practice Address - Street 1:245 REDWOOD AVE
Practice Address - Street 2:
Practice Address - City:WILLITS
Practice Address - State:CA
Practice Address - Zip Code:95490-3429
Practice Address - Country:US
Practice Address - Phone:707-459-4444
Practice Address - Fax:707-459-1444
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-14
Last Update Date:2007-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOT 1087225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist