Active NPI
Berkeley R Russ, COTA/L
- Occupational Therapy Assistant
- Tecumseh, NE
National Provider Identifier
1003180472
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapy Assistant
- License
- 856
- Practice address
- 1133 N 3Rd St
Tecumseh, NE 68450-2069 - Phone
- (402) 335-3357
- NPI assigned
- Mar 2, 2012
- Last updated
- Mar 2, 2012
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Occupational Therapy Assistant | 224Z00000X | 856 | NE | Primary |
Addresses
Primary practice location
1133 N 3Rd St
Tecumseh, NE 68450-2069
Mailing address
4523 Prescott Ave Apt 4
Lincoln, NE 68506-4964
Phone (320) 226-4591
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 856 | NE | MD | Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1330646400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1330646400000",
"number": "1003180472",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4523 PRESCOTT AVE APT 4",
"city": "LINCOLN",
"state": "NE",
"postal_code": "685064964",
"telephone_number": "320-226-4591"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1133 N 3RD ST",
"city": "TECUMSEH",
"state": "NE",
"postal_code": "684502069",
"telephone_number": "402-335-3357"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RUSS",
"first_name": "BERKELEY",
"middle_name": "R",
"name_prefix": "Miss",
"credential": "COTA/L",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2012-03-02",
"last_updated": "2012-03-02",
"status": "A"
},
"taxonomies": [
{
"code": "224Z00000X",
"taxonomy_group": "",
"desc": "Occupational Therapy Assistant",
"state": "NE",
"license": "856",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Tecumseh, NE
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 2, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.