=====================================================
General NPI Number Information
=====================================================
NPI Number | 1598902074
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KARI NICOLE BURT OTR/L
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/20/2009
-----------------------------------------------------
Last Update Date | 01/20/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 120 IRIS ST
-----------------------------------------------------
City | PAINTSVILLE
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 41240-9302
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 606-788-9101
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 120 IRIS ST
-----------------------------------------------------
City | PAINTSVILLE
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 41240-9302
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 606-788-9101
-----------------------------------------------------
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 | R4003
-----------------------------------------------------
License Number State | KY
-----------------------------------------------------