Healthcare Provider Details

I. General information

NPI: 1760787493
Provider Name (Legal Business Name): DEIDRA MICHELLE BURKE OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/11/2011
Last Update Date: 08/28/2026
Certification Date: 08/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

222 PLANTATION POINTE DR
ELGIN SC
29045-9189
US

IV. Provider business mailing address

222 PLANTATION POINTE DR
ELGIN SC
29045-9189
US

V. Phone/Fax

Practice location:
  • Phone: 803-968-1118
  • Fax:
Mailing address:
  • Phone: 803-968-1118
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-26-2841220
License Number StateSC
# 2
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: