=====================================================
General NPI Number Information
=====================================================
NPI Number | 1043616824
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KRISTA MCSHEA TODD-BURKE MS, OTR/L
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/06/2014
-----------------------------------------------------
Last Update Date | 11/06/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 815 CHESTER PIKE PROSPECT PARK HEALTH AND REHABILITATION CENTER
-----------------------------------------------------
City | PROSPECT PARK
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19076
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 610-389-9483
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 815 CHESTER PIKE PROSPECT PARK HEALTH AND REHABILITATION CENTER
-----------------------------------------------------
City | PROSPECT PARK
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19076
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225X00000X
-----------------------------------------------------
Taxonomy Name | Occupational Therapist
-----------------------------------------------------
License Number | OCO10608
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------