Provider Demographics
NPI:1366771503
Name:BERGER, JERYL L (OTR/L)
Entity type:Individual
Prefix:
First Name:JERYL
Middle Name:L
Last Name:BERGER
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:JERYL
Other - Middle Name:L
Other - Last Name:GRECIAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR/L
Mailing Address - Street 1:3011 LONGFORD DR
Mailing Address - Street 2:
Mailing Address - City:SPRING HILL
Mailing Address - State:TN
Mailing Address - Zip Code:37174-6200
Mailing Address - Country:US
Mailing Address - Phone:847-566-9860
Mailing Address - Fax:847-566-9861
Practice Address - Street 1:3011 LONGFORD DR
Practice Address - Street 2:
Practice Address - City:SPRING HILL
Practice Address - State:TN
Practice Address - Zip Code:37174-6200
Practice Address - Country:US
Practice Address - Phone:615-241-0122
Practice Address - Fax:844-308-4982
Is Sole Proprietor?:No
Enumeration Date:2009-12-17
Last Update Date:2021-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL056-004979174400000X
TN6224225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1366771503OtherNPI