MEDICARE: FLORELYN OLAVIDEZ BURGOS

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	46TR00468400	NJ
2	225X00000X	Occupational Therapist	117959	TX

General Provider Information

NPI Number	:	1952532756
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	FLORELYN OLAVIDEZ BURGOS

Provider Business Mailing Address
First Line	:	6229 JACKSTAFF DR
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76179-1171
Country	:	US
Telephone Number	:	201-936-2414
Fax Number	:

Provider Business Practice Location Address
First Line	:	6229 JACKSTAFF DR
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76179-1171
Country	:	US
Telephone Number	:	201-936-2414
Fax Number	:

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

Provider Enumeration Date	:	07/29/2009
Last Update Date	:	07/22/2025

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Directions to “ FLORELYN OLAVIDEZ BURGOS ” Practice Location

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