Provider Demographics
NPI:1861783482
Name:BERGER, JOYCE ELLEN
Entity type:Individual
Prefix:MRS
First Name:JOYCE
Middle Name:ELLEN
Last Name:BERGER
Suffix:
Gender:F
Credentials:
Other - Prefix:MR
Other - First Name:JOYCE
Other - Middle Name:ELLEN
Other - Last Name:DOWNIE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR/L
Mailing Address - Street 1:1781 HACKBERRY LN
Mailing Address - Street 2:
Mailing Address - City:LAKE FOREST
Mailing Address - State:IL
Mailing Address - Zip Code:60045-3515
Mailing Address - Country:US
Mailing Address - Phone:847-615-8162
Mailing Address - Fax:
Practice Address - Street 1:600 N BRADLEY RD
Practice Address - Street 2:
Practice Address - City:LAKE FOREST
Practice Address - State:IL
Practice Address - Zip Code:60045-1020
Practice Address - Country:US
Practice Address - Phone:847-615-8696
Practice Address - Fax:847-615-8656
Is Sole Proprietor?:No
Enumeration Date:2011-04-30
Last Update Date:2011-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL056-000744225X00000X, 225XN1300X, 225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No225XN1300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistNeurorehabilitation
No225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1891028247OtherEQUESTRIAN CONNECTION NFP