Active NPI
Jonah Alne Cristie Berdin
- Occupational Therapist
- Ellicott City, MD
National Provider Identifier
1487905147
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapist
- License
- 14095
- Practice address
- 3290 N Ridge Rd Ste 290
Ellicott City, MD 21043-3657 - Phone
- (410) 750-9006
- NPI assigned
- Sep 20, 2012
- Sex
- Female
- Sole proprietor
- Yes
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 Therapist | 225X00000X | 14095 | FL | Primary |
Addresses
Primary practice location
3290 N Ridge Rd Ste 290
Ellicott City, MD 21043-3657
Mailing address
3330 Lake Center Dr Apt 15106
Mount Dora, FL 32757-2374
Phone (505) 399-1487
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 |
|---|---|---|---|
| 14095 | FL | MD | Occupational Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1348099200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1348099200000",
"number": "1487905147",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3330 LAKE CENTER DR APT 15106",
"city": "MOUNT DORA",
"state": "FL",
"postal_code": "327572374",
"telephone_number": "505-399-1487"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3290 N RIDGE RD STE 290",
"city": "ELLICOTT CITY",
"state": "MD",
"postal_code": "210433657",
"telephone_number": "410-750-9006"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BERDIN",
"first_name": "JONAH ALNE CRISTIE",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2012-09-20",
"last_updated": "2012-09-20",
"status": "A"
},
"taxonomies": [
{
"code": "225X00000X",
"taxonomy_group": "",
"desc": "Occupational Therapist",
"state": "FL",
"license": "14095",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Ellicott City, MD
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 20, 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.