Healthcare Provider Details

I. General information

NPI: 1063034965
Provider Name (Legal Business Name): JOSLYN BURKE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/13/2020
Last Update Date: 05/13/2020
Certification Date: 05/13/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1834 STATE ROAD 25 W
LAFAYETTE IN
47909-9272
US

IV. Provider business mailing address

1834 STATE ROAD 25 W
LAFAYETTE IN
47909-9272
US

V. Phone/Fax

Practice location:
  • Phone: 765-588-7418
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225500000X
TaxonomyRespiratory/Developmental/Rehabilitative Specialist/Technologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: