Healthcare Provider Details

I. General information

NPI: 1508934274
Provider Name (Legal Business Name): SHAUNA DENISE BURCHETT OTRL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/01/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1605 W GARLAND AVE
SPOKANE WA
99205-2620
US

IV. Provider business mailing address

4820 N BEMIS ST
SPOKANE WA
99205
US

V. Phone/Fax

Practice location:
  • Phone: 509-444-8383
  • Fax: 509-444-8385
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XN1300X
TaxonomyNeurorehabilitation Occupational Therapist
License NumberOT00002144
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: