Basic Information
| Provider Information | |||||||||
| NPI: | 1811162191 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BERARDINO | ||||||||
| FirstName: | MELISSA | ||||||||
| MiddleName: | HERNANDO | ||||||||
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| Credential: | OTR/L | ||||||||
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| Mailing Information | |||||||||
| Address1: | 53 HAWTHORNE AVE | ||||||||
| Address2: | |||||||||
| City: | HOLMDEL | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 077331035 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7329667544 | ||||||||
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| Practice Location | |||||||||
| Address1: | 14 BRIDGEWATERS DR | ||||||||
| Address2: | |||||||||
| City: | OCEANPORT | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 077571162 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7325426600 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/28/2008 | ||||||||
| LastUpdateDate: | 08/02/2011 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225X00000X | 46TR00428700 | NJ | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist |
No ID Information.