MEDICARE: KELLY BURKE

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	103K00000X	Behavior Analyst
2	103K00000X	Behavior Analyst		PA

General Provider Information

NPI Number	:	1366942328
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KELLY BURKE

Provider Business Mailing Address
First Line	:	640 NEWLIN RD
Second Line	:
City	:	SPRINGFIELD
State	:	PA
Zip	:	19064-2815
Country	:	US
Telephone Number	:	610-724-3192
Fax Number	:

Provider Business Practice Location Address
First Line	:	606 E BALTIMORE PIKE FL 2
Second Line	:
City	:	MEDIA
State	:	PA
Zip	:	19063-1751
Country	:	US
Telephone Number	:	610-864-7376
Fax Number	:

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

Provider Enumeration Date	:	02/16/2018
Last Update Date	:	02/16/2018

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Directions to “ KELLY BURKE ” Practice Location

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