Healthcare Provider Details

I. General information

NPI: 1194546481
Provider Name (Legal Business Name): TALIA CLAIRE BURMANIA OTD, OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/21/2024
Last Update Date: 10/21/2024
Certification Date: 10/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4602 EASTPARK BLVD
MADISON WI
53718-2002
US

IV. Provider business mailing address

503 BOOTH ST APT 7
FOX LAKE WI
53933-9482
US

V. Phone/Fax

Practice location:
  • Phone: 608-440-6440
  • Fax:
Mailing address:
  • Phone: 920-296-6330
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XH1200X
TaxonomyHand Occupational Therapist
License Number8741-26
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: