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General NPI Number Information
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NPI Number | 1285880765
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Entity Type | Individual
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Provider Name | JOEL WILLIAM BURDE OTR
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Gender | Male
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Dates
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Enumeration Date | 08/15/2008
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Last Update Date | 08/15/2008
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Provider Practice Location Address
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Address Line | 2100 MIDWAY ST
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City | COLUMBUS
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State | IN
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Zip | 47201-3722
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Country | US
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Telephone | 812-372-8447
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Fax |
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Provider Business Mailing Address
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Address Line | 2 SALZBURG BLVD APT C
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City | COLUMBUS
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State | IN
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Zip | 47201-7125
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Country | US
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Telephone | 618-303-5553
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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 | 31004170A
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License Number State | IN
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