MEDICARE: KYLE BRADLEY BURKLUND OTR/L

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225X00000X	Occupational Therapist

General Provider Information

NPI Number	:	1366089096
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KYLE BRADLEY BURKLUND OTR/L

Provider Business Mailing Address
First Line	:	6550 W ANDREA DR
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85083-6518
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6550 W ANDREA DR
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85083-6518
Country	:	US
Telephone Number	:	714-715-3128
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/02/2019
Last Update Date	:	12/02/2019

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