Healthcare Provider Details

I. General information

NPI: 1003853334
Provider Name (Legal Business Name): REBECCA L BURT MA, CCC/SLP, NBCT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/02/2006
Last Update Date: 06/24/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 DERBY GLEN DR
ORLANDO FL
32837-8025
US

IV. Provider business mailing address

12242 MEDAN ST
ORLANDO FL
32837-9563
US

V. Phone/Fax

Practice location:
  • Phone: 407-641-0808
  • Fax: 407-812-4358
Mailing address:
  • Phone: 407-267-3205
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSA6431
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code222Q00000X
TaxonomyDevelopmental Therapist
License NumberSA 6431
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: