Denetrice Olivia Berry-Brunner, MSOTR/L

Key facts

NPI

1831793231

Entity type

Individual (NPI type 1)

Primary specialty

Occupational Therapist 225X00000X

License

3099 (SC)

Practice address

1 Martha Franks Dr
Laurens, SC 29360-1772

Phone

(864) 984-4541

NPI assigned

Nov 25, 2020

Sex

Female

Sole proprietor

No

Medicare participation

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)

No

State licenses

Specialties & licenses

Addresses

Other identifiers

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Nov 25, 2020.

{
    "created_epoch": "1606262400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1606262400000",
    "number": "1831793231",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "536 OLD HOWELL RD",
            "city": "GREENVILLE",
            "state": "SC",
            "postal_code": "296151969",
            "telephone_number": "864-244-3626"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 MARTHA FRANKS DR",
            "city": "LAURENS",
            "state": "SC",
            "postal_code": "293601772",
            "telephone_number": "864-984-4541"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BERRY-BRUNNER",
        "first_name": "DENETRICE",
        "middle_name": "OLIVIA",
        "name_prefix": "Ms.",
        "credential": "MSOTR/L",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-11-25",
        "last_updated": "2020-11-25",
        "certification_date": "2020-11-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": "SC",
            "license": "3099",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UPIN,MEDICARE, MEDICAID AND OTHERS",
            "identifier": "3099",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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All providers in Laurens, SC · Occupational Therapist in South Carolina