Healthcare Provider Details

I. General information

NPI: 1417151614
Provider Name (Legal Business Name): NICOLE A. BURNS OTR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/12/2007
Last Update Date: 10/07/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 NEWTOWN RD # A SUITE 5
DANBURY CT
06810-4114
US

IV. Provider business mailing address

31 OLD ROUTE 7
BROOKFIELD CT
06804-1714
US

V. Phone/Fax

Practice location:
  • Phone: 203-739-0765
  • Fax: 203-739-0792
Mailing address:
  • Phone: 203-740-0020
  • Fax: 203-775-0238

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number003183
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: