Individual
MRS. MICHELLE P BERRY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
OTR
Contact information
Practice address
6205 CONSTITUTION DR, FORT WAYNE, IN 46804-1517
(260) 385-2130
(260) 818-2044
Mailing address
6205 CONSTITUTION DR, FORT WAYNE, IN 46804-1517
(260) 385-2130
(260) 818-2044
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
31000293A
IN
225X00000X
Occupational Therapist
Primary
31000293A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200628720A
—
IN
Enumeration date
10/11/2007
Last updated
03/17/2018
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