| NPI | 1407907082 |
|---|---|
| Former Name | JACKY EILEEN BERG |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225XP0200X Occupational Therapist, Pediatrics (Licence: ND 816) |
| Additional Taxonomies | 225XP0200X Occupational Therapist, Pediatrics (Licence: MN 102599) |
| Enumeration Date | 2007-01-12 |
| Last Update Date | 2007-07-09 |