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General NPI Number Information
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NPI Number | 1235917519
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Entity Type | Individual
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Provider Name | PATRICIA CAMPBELL BURKS OTR/L
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Gender | Female
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Dates
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Enumeration Date | 09/19/2023
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Last Update Date | 09/19/2023
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Provider Practice Location Address
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Address Line | 10 W GROVE AVE
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City | LAKE WALES
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State | FL
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Zip | 33853-4516
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Country | US
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Telephone | 706-415-6771
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Fax |
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Provider Business Mailing Address
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Address Line | 1537 JUDY ST
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City | LAKE WALES
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State | FL
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Zip | 33898-6403
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Country | US
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Telephone | 706-415-6771
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | OT002566
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | OT23034
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License Number State | FL
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