Provider Demographics
NPI:1528438249
Name:BERRY, LISA (OT)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:BERRY
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14878 METCALF AVE
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66223-2206
Mailing Address - Country:US
Mailing Address - Phone:913-257-5808
Mailing Address - Fax:844-270-5788
Practice Address - Street 1:14878 METCALF AVE
Practice Address - Street 2:
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66223-2206
Practice Address - Country:US
Practice Address - Phone:913-257-5808
Practice Address - Fax:844-270-5788
Is Sole Proprietor?:No
Enumeration Date:2015-10-07
Last Update Date:2015-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS07-01452225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS17-01452OtherSTATE OF KANSAS LICENSE