Healthcare Provider Details

I. General information

NPI: 1043529068
Provider Name (Legal Business Name): MISS CHELSEA DANIELLE BURKE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/27/2010
Last Update Date: 09/27/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

54 HOSPITAL DR
OSAGE BEACH MO
65065-3050
US

IV. Provider business mailing address

414 COLLIER ST
MOKANE MO
65059-1317
US

V. Phone/Fax

Practice location:
  • Phone: 573-302-2230
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number2010033575
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: