Healthcare Provider Details

I. General information

NPI: 1801031299
Provider Name (Legal Business Name): BURKE CHANDLER M.A.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/13/2008
Last Update Date: 12/13/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 S COMMERCE ST CLUSTER BOX 3
ARDMORE OK
73401-3937
US

IV. Provider business mailing address

5 S COMMERCE ST CLUSTER BOX 3
ARDMORE OK
73401-3937
US

V. Phone/Fax

Practice location:
  • Phone: 580-223-3810
  • Fax: 580-223-5688
Mailing address:
  • Phone: 580-223-3810
  • Fax: 580-223-5688

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number32
License Number StateOK
# 2
Primary TaxonomyN
Taxonomy Code231HA2500X
TaxonomyAssistive Technology Supplier Audiologist
License Number32
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: