Healthcare Provider Details

I. General information

NPI: 1609332816
Provider Name (Legal Business Name): RICHARD AUSTIN BURROWS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/12/2019
Last Update Date: 02/12/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

689 S APOLLO BLVD
MELBOURNE FL
32901-1455
US

IV. Provider business mailing address

1954 ROCKLEDGE BLVD STE 119
ROCKLEDGE FL
32955-3761
US

V. Phone/Fax

Practice location:
  • Phone: 321-674-5035
  • Fax: 321-674-5039
Mailing address:
  • Phone: 321-433-1500
  • Fax: 321-433-1556

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT19781
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: