Healthcare Provider Details

I. General information

NPI: 1588536130
Provider Name (Legal Business Name): DEANNA MARIE BURKS OTRL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/23/2025
Last Update Date: 09/23/2025
Certification Date: 09/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4118 HERDSMAN DR
KRUM TX
76249-1556
US

IV. Provider business mailing address

4118 HERDSMAN DR
KRUM TX
76249-1556
US

V. Phone/Fax

Practice location:
  • Phone: 940-535-8105
  • Fax: 940-241-4204
Mailing address:
  • Phone: 940-535-8105
  • Fax: 940-241-4204

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number108202
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: