Individual
MRS. CHRISTINA BERRY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
215 SOUTH ST, SOUTHOLD, NY 11971-1996
(631) 765-8084
(631) 765-8897
Mailing address
215 SOUTH ST, SOUTHOLD, NY 11971-1996
(631) 765-8084
(631) 765-0013
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
0128821
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0128821
LICENSE
NY
01
—
11518456
CAQH
NY
01
—
2034188811
TAX ID
NY
Enumeration date
11/30/2005
Last updated
10/31/2018
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