=====================================================
General NPI Number Information
=====================================================
NPI Number | 1770736175
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | TAMMIE S. BURLEW OTR.L
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/29/2008
-----------------------------------------------------
Last Update Date | 10/29/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 44 ALGONQUIN DR
-----------------------------------------------------
City | HORSEHEADS
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 14845-1079
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 607-425-5132
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 44 ALGONQUIN DR
-----------------------------------------------------
City | HORSEHEADS
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 14845-1079
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 607-425-5132
-----------------------------------------------------
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 | 005315-1
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------