Provider Demographics
NPI:1427785153
Name:BERKOWITZ, LEORA BETH (OTR/L)
Entity type:Individual
Prefix:
First Name:LEORA
Middle Name:BETH
Last Name:BERKOWITZ
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 CLUB DR APT 4AL
Mailing Address - Street 2:
Mailing Address - City:WOODMERE
Mailing Address - State:NY
Mailing Address - Zip Code:11598-2003
Mailing Address - Country:US
Mailing Address - Phone:862-368-3812
Mailing Address - Fax:
Practice Address - Street 1:1 CLUB DR APT 4AL
Practice Address - Street 2:
Practice Address - City:WOODMERE
Practice Address - State:NY
Practice Address - Zip Code:11598-2003
Practice Address - Country:US
Practice Address - Phone:862-368-3812
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-03
Last Update Date:2022-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY023325225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist