Healthcare Provider Details

I. General information

NPI: 1881900223
Provider Name (Legal Business Name): JENNIFER LYNN BURKE OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/23/2010
Last Update Date: 08/23/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 PINNACLE PL SUITE 110
ALBANY NY
12203-3496
US

IV. Provider business mailing address

218 SHAKER RIDGE DR
NISKAYUNA NY
12309-1967
US

V. Phone/Fax

Practice location:
  • Phone: 518-461-7840
  • Fax:
Mailing address:
  • Phone: 518-862-0209
  • Fax: 518-862-0245

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number003285-1
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code225XM0800X
TaxonomyMental Health Occupational Therapist
License Number003285-1
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code225XP0019X
TaxonomyPhysical Rehabilitation Occupational Therapist
License Number003285-1
License Number StateNY
# 4
Primary TaxonomyN
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number003285-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: