Most Relevant Information
Provider Data
| NPI Number: | 1003180472 |
| Provider Name: | BERKELEY R RUSS COTA/L |
| Entity Type: | Individual |
| Taxonomy Code: | 224Z00000X |
| Specialty: | Occupational Therapy Assistant |
| License Number: | 856 |
Most Important Dates
| Enumeration Date: | 03/02/2012 |
| Last Updated: | 03/02/2012 |
Provider Practice Location
1133 N 3RD ST
TECUMSEH
NE
684502069
Practice Location Phone/Fax
| Phone: | 4023353357 |
| Fax: |
Provider Mailing Location
4523 PRESCOTT AVE APT 4
LINCOLN
NE
685064964
Provider Mailing Phone/Fax
| Phone: | 3202264591 |
| Fax: |